| NPI | 1104100395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY S EDWARDS Clinical Manager 678-653-0045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: GA 051126) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: GA 051126) | |
| 207RI0001X Internal Medicine, Clinical & Laboratory Immunology | |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2022-02-01 |