| NPI | 1689859720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAROLETT MITTIE ENGRAM Practice Administrator 229-387-9205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 049713) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-01-08 |