| NPI | 1437288636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA L. JESSIE Billing Manager 706-432-4858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: GA PHRE004369) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2020-08-22 |