| NPI | 1477872760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM PAUL CFO 770-716-2680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 60026) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2010-05-26 |