| NPI | 1609190198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE MARTIN Credentialing 706-782-0471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2017-02-02 |