| NPI | 1104399674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL STALLWORTH Practice Manager 404-997-0167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2019-01-08 |