| NPI | 1225328578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA SUTHERLAND Provider Enrollment 229-891-9131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: GA 65803) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2023-07-28 |