| NPI | 1639441744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS WAYNE HAGINS Owner 229-924-4156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA 118093) |
| Enumeration Date | 2012-02-04 |
| Last Update Date | 2018-04-19 |