| NPI | 1184896573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY R CRUMP Patient Care Coordinator 770-386-5262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2008-03-26 |