| NPI | 1417393885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEUSTACE N LEWIS Owner 706-616-8031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: GA NTP001075) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2013-05-13 |