| NPI | 1215483128 |
|---|---|
| Doing Business As | ERICKA RUSSELL-PETTY |
| Entity Type | Organization |
| Authorized Contact | ERICKA RUSSELL-PETTY Physiciann 912-777-5490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: GA 047258) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2016-08-30 |