NPI | 1366881641 |
---|---|
Entity Type | Organization |
Authorized Contact | DANIEL RAY GASKIN Owner 912-352-9902 |
Organization Subpart ? | No |
Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: GA 028117) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: GA LPC002856) |
174400000X Specialist (Licence: GA 022469) | |
Enumeration Date | 2013-06-19 |
Last Update Date | 2013-06-19 |