| NPI | 1023891504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEOPHILUS OHAYAGHA Administrator/Director 404-707-0631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2025-03-24 |