| NPI | 1497046882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK E UNDERWOOD Clinician 770-339-2259 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA APC002422) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2011-04-20 |