| NPI | 1104967850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK BRICKHOUSE Director Of Operations 770-455-0040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-08-22 |