| NPI | 1457692956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LEACH Team Finance Leader 678-736-6342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 026769) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 038861) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2013-03-07 |