| NPI | 1518557073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA L CLEMENTS Owner/Provider 706-982-2721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208000000X Pediatrics |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2021-05-25 |