| NPI | 1639824568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAQUITA CHARRISE GATEWOOD Practice Administrator 678-314-3138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-02-18 |