| NPI | 1558416701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUETTA CODY Manager, Provider Enrollment 404-785-7876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2023-03-28 |