| NPI | 1407174675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMI W SORRELLS CEO 770-815-0986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2020-10-19 |