| NPI | 1275710998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON E COX Office Manager 706-359-2419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 046168) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2008-01-24 |