| NPI | 1508134156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARROLL BRADDY CEO 770-892-5284 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW003727) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2022-01-06 |