| NPI | 1558911677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT HORSFORD Owner 770-990-0823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QC1500X Clinic/Center Community Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-09-19 |