| NPI | 1639439631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN OVERBY Administrator 706-221-6116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 67863) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2012-05-23 |