| NPI | 1982945135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY RAY ELLIOTT President 706-517-0656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN115578) |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2013-03-13 |