| NPI | 1114342474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAHANN VAUGHN Managed Care Coordinator 770-822-3600 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |