| NPI | 1184869299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY BOLES MCKAY Manager 706-845-1601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY002848) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY002670) |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2008-12-04 |