| NPI | 1154193936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA C WILSON Revenue Cycle Manager 706-322-9599 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-10-25 |
| Last Update Date | 2023-10-25 |