| NPI | 1982746087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY JOHNSON Human Resource Manager 601-948-5572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2022-04-28 |