| NPI | 1770766909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN E. FUSSELL Owner 706-324-4177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 026777) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2008-03-31 |