| NPI | 1134422157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARIE CRANDALL Managing Partner 678-957-1043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA GA042979) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: GA RN173213 NP) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2010-12-14 |