| NPI | 1104000660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARA M PICAYO Physician / President 770-926-2757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 058381) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2011-01-28 |