| NPI | 1932890159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE G WALLS Credentialing Coordinator 912-278-9788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2023-05-21 |