| NPI | 1346192366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY GORDON Owner 770-932-2662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2026-02-11 |
| Last Update Date | 2026-02-11 |