| NPI | 1023537321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLIE INCLAN Credentialing 404-564-9345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2021-06-05 |