| NPI | 1164177085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH DIFABIO Cmo 770-203-3998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X Community/Behavioral Health | |
| 261QH0100X Clinic/Center, Health Services | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-02-18 |