| NPI | 1790147908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD RICKMAN Medical Doctor 229-469-7729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 049332) |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2016-05-23 |