| NPI | 1801119375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD W. WIECZOREK Registering Agent 706-327-4880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2014-02-25 |