| NPI | 1043544968 |
|---|---|
| Former Legal Business Name | NA |
| Entity Type | Organization |
| Authorized Contact | MICHAEL WINFREE Program Administrator 770-413-1690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA 0000000000) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2009-09-24 |