| 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 |