| NPI | 1992468482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA JORDAN Provider Enrollment COO Rdinator 229-891-9131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Female Pelvic Medicine and Reconstructive Surgery |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2021-10-21 |