| NPI | 1639574890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDDY LAJARA General Manager 770-831-9202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 38981) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA chir008572) |
| 363L00000X Nurse Practitioner (Licence: GA RN105078) | |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2021-01-25 |