| NPI | 1043605587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY P LUMPKIN Owner 706-712-0118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 0000041282) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: GA 0000041282) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2015-04-01 |