| NPI | 1972160422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL R SORRELLS CFO 478-237-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2019-05-21 |