| NPI | 1598708224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVINS S DAVIS Owner 706-745-9220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 45765) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2008-01-18 |