| NPI | 1144977802 |
|---|---|
| Doing Business As | JACKSON L GATES |
| Entity Type | Organization |
| Authorized Contact | JACKSON L GATES Owner 678-591-6509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2022-03-03 |