| NPI | 1972111797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOLANDA EVETTE STAFFORD Family Nurse Practitioner 912-464-2998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2021-08-25 |