| NPI | 1629251699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISE GERBSCH GRESHAM Practice Manager 912-355-6029 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 026286) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2007-12-12 |