| NPI | 1447630876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN YOUNG Administrator 678-673-5108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 056-HOS-001) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2015-06-01 |