| NPI | 1043965056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY BUFFINGTON Credentialing Director 706-620-4494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2022-02-17 |