| NPI | 1821500042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA RAGER Director Revenue Cycle 844-969-0686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 79130) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 79130) |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2025-01-10 |