| NPI | 1992351910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA LOUISE HUDSON Practice Manager 910-500-6451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2020-02-11 |