| NPI | 1659818482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANE MAURISHA LANG Physician 404-396-3997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 305R0000X) |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2017-01-31 |