| NPI | 1124343132 |
|---|---|
| Doing Business As | MARCUS LOGAN |
| Entity Type | Organization |
| Authorized Contact | ALICIA MICHELLE HOWARD Credentialing 706-670-1080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2023-02-10 |