| NPI | 1598957011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C GORDON Owner 770-801-0980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: GA 026534) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2007-08-17 |