| NPI | 1235515438 |
|---|---|
| Doing Business As | GULFSTREAM CHILDREN'S WELLNESS PROGRAM & CENTER |
| Entity Type | Organization |
| Authorized Contact | SEBRENA C. HOLMES GIBSON Provider Enrollment Coordinator 912-350-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine | |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2015-08-11 |