| NPI | 1962056036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN NORTHEN LACY Physician Owner 901-289-0915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology Gynecology |
| Enumeration Date | 2019-07-27 |
| Last Update Date | 2019-11-01 |