| NPI | 1780964841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLIPHANE W MCLEOD Owner 912-373-7035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA GA029212) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2011-08-22 |