| NPI | 1295885465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES EDGAR LEAKE Medical Director 770-421-1242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA 261QA1903X) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-08-22 |