| NPI | 1952940454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODY WILLIAMS GOSS Office Manager 662-563-8703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2020-01-13 |