| NPI | 1376917591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIQUELLA SHANTEL KING-WHITBY CEO 404-449-0545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: GA 58891) |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation (Licence: GA 58891) |
| Enumeration Date | 2015-11-27 |
| Last Update Date | 2015-11-27 |