| NPI | 1922577428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN RYCROFT Credentialing Supervisor 478-783-0299 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2018-11-14 |