| NPI | 1992999205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE F LORD Medical Staff Assistant 912-383-5623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA 03941) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2007-08-29 |