| NPI | 1356401996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATSY MOORE Mediciad Clerk 912-383-5338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| 347B00000X Bus | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-08-22 |