GEORGIA DEPARTMENT OF HUMAN RESOURCES

NPI # 

Practice Address:

16 E 12Th St Sw

Rome, GA, 30161-4720

Practice Phone:

706-802-5343

Practice Fax:

706-802-5681

License Number:

025271

License State:

GA

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Public Health, State or Local

Taxonomy Code:

261QP0905X