| NPI | 1467721001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM STANFORD Pcm Manager 770-383-3565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: GA RN172144) |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2011-12-28 |