| NPI | 1932741857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA FIELDS Director 706-446-5587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2021-05-12 |