| NPI | 1972791978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER C BULLOCK President 662-534-2298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 213E00000X Podiatrist |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2024-08-26 |