| NPI | 1467547281 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK R EADES Owner Physician 912-303-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: GA 043360) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: SC 20053) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2016-03-23 |