| NPI | 1477093839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALI L MCCORKLE Program Director 706-552-0688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA NTP001005) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2017-03-06 |