| NPI | 1265456669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA TANNER Physician 912-384-2353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 53885) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004691) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-01-19 |