| NPI | 1023760790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THADDEUS GARLAND Owner 678-617-2372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-01-24 |
| Last Update Date | 2022-04-29 |