| NPI | 1851830806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA JEAN UTERMARK President 706-860-5884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 8593) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-02-22 |