| NPI | 1962189449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN MIRACLE CEO 706-946-5610 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2024-09-19 |