| NPI | 1962293084 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | JUSTIN PARDEN Owner/AO 334-659-4717 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 2086S0129X | 
| Additional Taxonomies | 207Q00000X Family Medicine | 
| Enumeration Date | 2025-05-16 | 
| Last Update Date | 2025-05-16 |