| NPI | 1538246251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA ROBERSON Credentialing 770-428-4475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: GA 033-314) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: GA 11C0001268) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-05-22 |