| NPI | 1619307220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOSCO DAVIS Director/Administrator 706-464-4468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 106-R-1087) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2013-11-18 |