| NPI | 1679612733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH ANN SULLIVAN President 706-335-2034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 2010001281-58996) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2010-11-17 |