| NPI | 1316643315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA RANDLE Provider 770-726-3577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2024-03-01 |