| NPI | 1083944771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN RAE CHANDLER-MORGAN Member 229-591-0024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 2315) |
| Enumeration Date | 2010-01-03 |
| Last Update Date | 2010-01-03 |