| NPI | 1831432962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JAMES DANIEL Office Manager 912-354-5734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 14755) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2013-06-10 |