| NPI | 1164940672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGETTE HANNIGAN Chief Executive Officer 678-755-5334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2022-07-21 |