| NPI | 1427851708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY DEFORE Operations Manager 478-508-3308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2025-03-31 |
| Last Update Date | 2025-03-31 |