| NPI | 1962290676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY MYERS CASTLE Director Of Payor Contracts 912-732-1504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2025-04-30 |
| Last Update Date | 2025-04-30 |