| NPI | 1558637637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA KAY WARREN President 678-641-1828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 003-R-0407) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2012-03-22 |