| NPI | 1457759847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE DEASON Director 706-774-8326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 078396) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2018-11-27 |