| NPI | 1154756369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANELYN F GASTON Practice Administrator 706-468-4519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2014-10-15 |