| NPI | 1609249903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA ROBIN OLIVER Insurance Coordinator 706-549-4748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 012101) |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2015-11-09 |