| NPI | 1972998953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG M KIRK CEO 229-924-2885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA LPC 0002475) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2015-04-06 |