| NPI | 1508169426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SANFORD Office Manager 478-471-8593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 038434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 061948) |
| 207Q00000X Family Medicine (Licence: GA 002499) | |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2010-12-15 |