| NPI | 1063787901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAMONA ANN MINNIS Medical Director 678-705-1691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 042668) |
| Enumeration Date | 2012-03-11 |
| Last Update Date | 2012-03-11 |