| NPI | 1164569158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN INGRAM BAXTER Office Manager 770-739-9971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 027963) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-08-22 |