| NPI | 1174890081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARRIS D GRANSBERRY Pharmacist 404-422-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0003X Pharmacy, Managed Care Organization Pharmacy (Licence: GA RPH021895) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: GA RPH021895) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA RPH021895) | |
| Enumeration Date | 2011-11-20 |
| Last Update Date | 2011-11-20 |