| NPI | 1013120336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA CAROL JACKSON Owner 770-889-7465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 058148) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2008-05-12 |