| NPI | 1619101813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK PATRICK DOURRON Office Manager 770-996-9681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 014308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 027722) |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2009-05-04 |