| NPI | 1164884078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANINA LASSITER Owner 678-561-4522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: GA 1744P3200X) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 1744P3200X) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2018-03-08 |