| NPI | 1013377530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEBRENA HOLMES GIBSON Provider Enrollment Coordinator 912-350-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine | |
| 2080P0205X Pediatrics, Pediatric Endocrinology | |
| 2080P0207X Pediatrics, Pediatric Hematology-Oncology | |
| 208100000X Physical Medicine & Rehabilitation | |
| 208600000X Surgery | |
| 208C00000X Colon & Rectal Surgery | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) | |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2016-02-25 |