| NPI | 1154796563 |
|---|---|
| Doing Business As | MDMDS1992LLC |
| Entity Type | Organization |
| Authorized Contact | MELISSA BARNEY Practice Manager 706-705-6070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 061022) |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2015-12-10 |