| NPI | 1801285887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMARA JEAN NICHOLSON Office Manager 706-896-4673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 64384) |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2015-01-14 |