| NPI | 1396163820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY FAULK DAVIS Owner 912-614-6780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN120009) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2020-09-01 |