| NPI | 1508255308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADA V BENTON Owner 404-823-8229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 00237982) |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2015-01-16 |