| NPI | 1861745119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MARRERO Administrator 912-303-3552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: GA 047425) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 020999) |
| 207R00000X Internal Medicine (Licence: GA 038715) | |
| 207W00000X Ophthalmology (Licence: GA 026247) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 064752) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 039937) | |
| 363A00000X Physician Assistant (Licence: GA 5306) | |
| 363L00000X Nurse Practitioner (Licence: GA RN077768) | |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2012-10-24 |