| NPI | 1255465217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RICHARD JACKSON Md / Owner 770-655-1408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 056102) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2013-03-22 |