| NPI | 1891011516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN H. ROSS Practice Manager 912-352-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 055437) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2012-07-24 |