| NPI | 1659374825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN OGLE Coord. Clinical Admin Srvcs 706-324-7700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 009060) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2012-10-11 |