| NPI | 1336492727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THADDEUS KEDRON LYNN Owner/Physician 678-773-7419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 059670) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2015-04-27 |