| NPI | 1962094441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA SHANNON Owner / Physician 601-398-1949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology |
| Enumeration Date | 2021-02-06 |
| Last Update Date | 2021-07-12 |