| NPI | 1285134999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER B WANNER Owner 470-253-7944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 52651) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: GA RN229572) |
| 363LF0000X Nurse Practitioner Family (Licence: GA RN229572) | |
| Enumeration Date | 2018-02-19 |
| Last Update Date | 2018-03-08 |