| NPI | 1265210876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE BONE Billing Admin 706-406-1101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LA2100X Nurse Practitioner, Acute Care | |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2025-11-06 |