| NPI | 1336478759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA JESSIE Billing Manager 706-432-4858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2009-12-14 |