| NPI | 1174905830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN A GLENN Medical Director 478-290-8509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA 038495) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 038495) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2024-01-13 |