| NPI | 1992901128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELVIN L DOUGLAS Doctor 901-367-1116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TN MD0000026349) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2020-08-22 |