| NPI | 1235547431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDDIE RICHARDSON Physician/Practice Owner 706-484-0884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 7235) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2014-07-31 |