| NPI | 1104294461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE SEWELL Md, Faap 404-386-6510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 036281) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2015-09-03 |