| NPI | 1851924377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA C WILSON Revenue Cycle Manager 706-322-9599 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2020-08-03 |