| NPI | 1518096122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTH CLARK Practice Administrator 770-455-4009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 037539) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2023-01-04 |