| NPI | 1750625364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH EDWARD DINELLA Authorized Official 229-928-8868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 036716) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2012-11-20 |