| NPI | 1043568264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB DEAN BOSTWICK Director Of Finance 706-922-0600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2019-02-15 |