| NPI | 1013100130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PADMASHRI KOMANDUR SRINIVASA Provider 770-623-1331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 059872) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |