| NPI | 1568596799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE A MITCHELL Executive Vice President 770-998-8936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2022-07-21 |