| NPI | 1679196349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DAVIS Credentialing Specialists 912-484-3879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2021-03-18 |