| NPI | 1023153244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL L CHURCH Owner 706-896-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 048990) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: GA 048990) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2016-02-29 |