| NPI | 1265083539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSAUNDRA ANGELINA BURKS Practitioner 678-666-2545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 174200000X |
| 251K00000X Public Health or Welfare | |
| 252Y00000X Early Intervention Provider Agency | |
| 302R00000X Health Maintenance Organization | |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2019-09-26 |