| NPI | 1609909654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIENNE A. WILSON Sec. Treas. 770-433-2820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 7823) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-08-22 |