| NPI | 1356620454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVONNE WICKS Manager 404-790-0911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: GA 65587) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: GA 005833) |
| 363AM0700X Physician Assistant, Medical (Licence: GA 004315) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2011-08-23 |