| NPI | 1518255777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C GORDON Owner 770-801-0980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: GA 26534) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2011-07-21 |