| NPI | 1629693411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISHA DURU Administrator 770-686-7002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| 261QH0100X Clinic/Center Health Service | |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2020-06-08 |