| NPI | 1043981517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLENE MARTIN Practice Manager 770-990-8212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 261QR1100X Clinic/Center Research | |
| 261QU0200X Clinic/Center Urgent Care | |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2021-09-24 |