| NPI | 1053342774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT TIMOTHY STARK Physician 912-287-1621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 045632) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2010-10-01 |