| NPI | 1679083539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMA GODWIN Contracting And Credentialing 229-529-1475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: GA 1659.1) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2026-03-31 |