| NPI | 1245682079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TUCOLA NECHELL CALISKAN Administrator/Delegated Official 706-524-2474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2016-07-05 |