| NPI | 1508138561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAIYSHA TANIA CLAIRBORNE President/CEO 404-478-9868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: GA 055194) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: GA 055194) |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2012-02-06 |