| NPI | 1659451805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS ROLAND Facility Admin 706-868-3330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA RN052799) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2020-08-22 |