| NPI | 1386739498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID C ALLEN President 706-543-2718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261QL0400X Clinic/Center, Lithotripsy (Licence: GA 029-044) |
| 261QR0200X Clinic/Center, Radiology | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2008-11-05 |