| NPI | 1821825043 |
|---|---|
| Doing Business As | CONVIVA WIREGRASS |
| Entity Type | Organization |
| Authorized Contact | ANGIE MARTINEZ Senior Credentialing Professional 407-447-7120 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208D00000X General Practice | |
| Enumeration Date | 2024-09-19 |
| Last Update Date | 2024-09-19 |