| NPI | 1366412710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA G CANNON Insurance Administrator 229-432-7012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 11C0001270) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-09-06 |