| NPI | 1164801460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLY NICHOLS Statewide Medical Director 229-249-4971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: GA rn135376) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2015-05-20 |