| NPI | 1043961980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY WOOD CFO 706-790-4440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-01-12 |