| NPI | 1962817601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY HASH Provider Enrollment Coordinator 912-350-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2022-03-18 |