| NPI | 1578983060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL ARNETT BELL Administrator 229-516-7095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: GA 13395448) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-23 |