| NPI | 1134519077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEDRA S FORTSON Nurse Practitioner 770-330-8496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA RN131505) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2019-07-10 |