| NPI | 1619207420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN M. NICHOLS Office Manager 912-261-2999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN010949) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2009-12-30 |