| NPI | 1124416367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY GALLUPS Medical Director 770-740-1860 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: GA 58959) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2018-11-08 |