| NPI | 1912627126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS BRADDY Practice Administrator 478-295-0526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2022-08-30 |