| NPI | 1225462369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND EASLEY Medical Director 770-955-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 66224) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2013-11-05 |