| NPI | 1376145318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTRANIKA D. ROSS Nurse Practitioner 678-749-5702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health |
| 363LG0600X Nurse Practitioner Gerontology | |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2022-09-07 |