| NPI | 1174716989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB DEAN BOSTWICK Director Of Finance 706-922-0600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 122300000X Dentist |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2019-02-15 |