| NPI | 1447924535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONDI NICHOLE LITTLE Office Manager 912-500-9207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2023-07-12 |