| NPI | 1154449486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE LECLAIRE Office Manager 770-822-3031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 026300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 026300) |
| 208100000X Physical Medicine & Rehabilitation (Licence: GA 026300) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |