| NPI | 1447688163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAMP MATHIS Manager 678-705-8261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: GA 159564lgb) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: GA 159564lgb) |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2013-10-15 |