| NPI | 1811233828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA J STEPHENS Credentialing Coordinator 912-819-7878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2017-01-23 |