| NPI | 1609087469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA L CASEY Office Manager 229-241-0041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 049332) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2011-02-10 |