| NPI | 1144633066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY J CHARLOT Director 770-256-2739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN187056) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2014-06-09 |