| NPI | 1457500837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA C. FITZGERALD Physician 770-838-5828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA D29480) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2008-09-10 |