| NPI | 1992448476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | URSULA ROSA Credentialing & Privileging Manager 706-922-0600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2025-07-28 |