| NPI | 1164636320 |
|---|---|
| Doing Business As | SOUTHCOM CLINIC-FT. GORDON |
| Entity Type | Organization |
| Authorized Contact | MARVIN PRIMOS Ubo Manager 706-787-7204 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient |
| Additional Taxonomies | 332000000X MilitaryU.S. Coast Guard Pharmacy |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2015-01-05 |