| NPI | 1740276039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA G CANNON Insurance Administrator 229-432-7012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 021643) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2007-10-22 |