| NPI | 1063878106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAHIDA PATKA Owner 478-625-7597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: GA 11-3954) |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: GA 11-3965) |
| 261QR1300X Clinic/Center, Rural Health (Licence: GA 11-3948) | |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2016-04-04 |