| NPI | 1922364629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP W. COOPER Clinacal Director 912-544-0484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA C-A8412) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2012-04-06 |