| NPI | 1245056480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANISHA HODGE CFO 678-935-9939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2024-12-05 |