| NPI | 1629236641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARROLL LEAH WIGGINS Practice Administrator 229-924-2383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 58226) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2008-05-27 |