| NPI | 1639113921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NDEM NDEM Owner 706-653-5544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 233865) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2020-08-22 |