| NPI | 1124497938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE D GARRISON CEO/President 770-655-7072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 3908-3909) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2015-09-22 |