| NPI | 1336651702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGETTE HANNIGAN Administrator 678-755-5334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA RN120872) |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2017-10-25 |