| NPI | 1518339795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERI ANN KING Executive Director 706-781-7957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health (Licence: GA LPN057830) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: GA LPN057830) |
| 261QR1300X Clinic/Center Rural Health (Licence: GA LPN057830) | |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2015-10-27 |