| NPI | 1578569323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORIS LYNN DAVIS Credentialing Mgr 770-879-5553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: GA 038143) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2022-11-20 |