| NPI | 1336909324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEE ALICE MOTON Owner 706-627-6005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 171400000X |
| 261QM2500X Clinic/Center Medical Specialty | |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2024-03-19 |