| NPI | 1073894911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEWELL TOUSSIANT Owner 770-736-2984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN DN014167) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2011-09-06 |