| 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 |