| NPI | 1700094562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BANTWAL P BALIGA Physician 706-507-2050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 056683) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2022-09-13 |