| NPI | 1508185265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERNON E SPELLMAN Practice Administrator 678-872-8755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 023819) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2015-04-29 |