| NPI | 1225321508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | R. L. TALLEY Md/Owner 770-760-9360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 029957) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: GA 29957) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2015-04-29 |