Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2006-07-18
- Last updated
- 2020-08-22
Licenses
- License GA
- 11321521
Location
- Practice location
- 721 N DOWNING MUSGROVE HWY
- City
- GLENNVILLE GA
- Postal code
- 304272208
- Phone
- 912-654-2141
Organization contact
- Name
- MARTHA TATUM
- Title
- CEO
- Phone
- 9127395105
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.