| NPI | 1194046771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELVIN BERTRAM BURTON CEO 770-942-1044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2020-05-13 |