| NPI | 1184819930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK R LIGHT Physician 770-977-8221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 11C0001132) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2012-06-28 |