| NPI | 1457097636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENDA ROSE HOUGHTON Owner/CEO 678-925-4276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2022-05-10 |