| NPI | 1164772984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN KAYE BLANK Cmo 770-696-9862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2012-09-19 |