| NPI | 1073192985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB BOSTWICK CFO 706-396-1474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-04-07 |