| NPI | 1033689336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER JUSTISS Controller 678-593-3332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2022-06-01 |