NPI | 1063721785 |
---|---|
Entity Type | Organization |
Authorized Contact | PHILIP F MACON Owner 770-455-4600 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 11414) |
Enumeration Date | 2010-09-29 |
Last Update Date | 2010-09-29 |