| NPI | 1932425220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMARA J NICHOLSON Office Manager 706-896-4673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 63815) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2010-04-13 |