| NPI | 1437436094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHELUKALA BAFU REDDY Doctor 770-228-9719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 27431) |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2011-11-10 |