| NPI | 1730214735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY ELLEN DURHAM President 912-748-4494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN011541) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |