| NPI | 1639319502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY C COUILLARD Operations Director 770-736-1735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 043268) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: GA 043268) |
| 208D00000X General Practice (Licence: GA 043268) | |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2009-03-04 |