| NPI | 1649454265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA WHITE Medical Biller 678-637-9155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 1689894883) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 1538167119) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2007-12-18 |