| NPI | 1629521885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENYA GREER Owner 706-664-6390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA LPC008269) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-07-25 |