| NPI | 1508195504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WESLEY WILSON Owner/Manager 404-246-1257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA PSY003201) |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2009-12-22 |