| NPI | 1972059780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PENNINGTON Executive Director 706-738-5039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 121R0030) |
| Additional Taxonomies | 261QA0600X Clinic/Center Adult Day Care |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2023-03-06 |