| NPI | 1235378324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY J MATECHAK Physician 770-422-5880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 52992) |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2009-02-12 |