| NPI | 1215171459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA H. THEDFORD Owner 770-968-1997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 054039) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 054039) |
| 208000000X Pediatrics (Licence: GA 054039) | |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2009-04-30 |