| NPI | 1881947802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MARRERO Administrator 912-303-3552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 042084) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 039759) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2012-10-16 |