| NPI | 1083986681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OTIS BONNER Attorney 770-866-5488 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |