| NPI | 1285929018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTY AQUINO Director, Provider Enrollment 470-895-0214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 261QP2300X Clinic/Center, Primary Care (Licence: GA RN130109) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2023-04-11 |