| NPI | 1619037314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN EDWARD LOVETT Director 706-793-1949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 2006#002837) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-22 |