| NPI | 1134462328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY L. SULLIVAN President/CEO 706-267-7479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA LD000433) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2013-04-05 |