| NPI | 1629519202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE KOMBE Fnp 404-579-1658 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health (Licence: GA 193760) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: GA 193760) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-03-15 |