| NPI | 1568977940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE OLIVER HALSTEAD President 276-285-3911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2019-03-25 |