| NPI | 1942974167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA ANN BECKUM Practice Manager/Office Manager 912-293-2869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2021-11-16 |