| NPI | 1588722326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE KYRIN DUNSTON Officer 912-692-0606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 004671) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-04-03 |