| NPI | 1396924692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH WARNER Billing Administrator 770-458-1594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TR0400X Psychologist, Rehabilitation (Licence: GA 1078) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2007-11-02 |