| NPI | 1013064039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE A MITCHELL EVP And General Counsel 770-998-8936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-08-22 |