| NPI | 1093181000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA P BLACK Owner 404-295-6251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 15074174) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2015-08-12 |