| NPI | 1962517185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY ELLIS-STAMPLEY CEO 601-786-3475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2010-12-29 |