| NPI | 1659432326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA DIANE CHRISTIE Office Manager 706-793-8242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 121-03-017-1) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2008-06-19 |