| NPI | 1841739984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRELL JENKINS Owner 912-978-8282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 047470140) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-02-22 |