| NPI | 1225576986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLEY CHENEY Owner 770-254-8787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA DN013135) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |