| NPI | 1447861950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVERNE W POINDEXTER Chief Executive Officer 770-270-5229 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2020-08-10 |