| NPI | 1023744422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA REEDER Practice Administrator 470-589-7120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QM2500X Clinic/Center, Medical Specialty | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2024-01-19 |