| NPI | 1639696529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEREE MOON Practice Administrator 470-297-1123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2021-05-19 |