| NPI | 1124470570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PADMA NAGALAKSHMI MUNUKUTI Md 678-264-9441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: TX N5269) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2019-11-15 |