| NPI | 1235569344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORETTA JOHNSON MCCLEE Owner 678-913-9169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: FL CL1230175) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2013-11-26 |