| NPI | 1952781759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE THOMPSON Supervisor 706-721-5505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 070267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 059603) |
| 207Q00000X Family Medicine (Licence: GA 061328) | |
| 207Q00000X Family Medicine (Licence: GA 034164) | |
| 207R00000X Internal Medicine (Licence: GA 045791) | |
| 207R00000X Internal Medicine (Licence: GA 036164) | |
| 207R00000X Internal Medicine (Licence: GA 073402) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: GA 013142) | |
| 207R00000X Internal Medicine (Licence: GA 047852) | |
| 207R00000X Internal Medicine (Licence: 037166) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: GA 048738) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: GA 026588) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: GA 009537) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2022-11-09 |