| NPI | 1629840814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PIERCE Director 678-239-4046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2024-10-29 |