| NPI | 1114162369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY HELEN JOHNSON Practice Administrator 404-255-4347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 036627) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2021-08-20 |