| NPI | 1528407608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH WILLOUGHBY FOGARTY Owner 770-539-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 041118) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2014-05-15 |