| NPI | 1447979901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER JUSTISS Controller 678-593-3332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2022-08-26 |