| NPI | 1235439167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRATIANA WILSON TAYLOR Owner 678-209-9420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA LPC006127) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2010-11-03 |