| NPI | 1669041810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY L DAVIS Credentialing Specialists 912-373-4385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2021-06-22 |