| NPI | 1457725152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALMENA SMITH Billing Manager 762-499-6961 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: GA 29631) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2018-07-11 |