| NPI | 1306910047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY L DEWITT Member 706-208-1408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 027533) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 055115) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |