| NPI | 1053691311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD WT PHILIP Practice Manager 678-263-6713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 142462) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2011-08-25 |