| NPI | 1275308207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATHONIA BENNETT Director 912-996-3303 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 171400000X Health & Wellness Coach | |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| 261QR1300X Clinic/Center, Rural Health | |
| 292200000X Dental Laboratory | |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2025-05-28 |