| NPI | 1003269002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE S VAZ Manager 404-580-8022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: GA RN172992NP) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2016-07-14 |