| NPI | 1609916337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER P SIMONS Administrative Assistant 478-272-8580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 052127) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 017714) |
| 174400000X Specialist (Licence: GA 017442) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2021-02-01 |