| NPI | 1063823482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMMAD MOHABUBUR RAHMAN Provider/Physician/Owner 478-405-2121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 044065) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: GA 044065) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: GA 044065) | |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2014-05-20 |