| NPI | 1104285659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALMENA SMITH Billing Manager 706-850-9041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 29631) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2018-07-11 |