| NPI | 1649421462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY LAWSON Administrator 678-423-7065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: AL 7906) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 7906) |
| 208D00000X General Practice (Licence: AL 7906) | |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2011-09-07 |