| NPI | 1619517968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT TIMOTHY CARROLL Owner/Physician 678-897-9867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2020-01-14 |