| NPI | 1669683546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERMAINE D. CUMMINGS Medical Doctor 770-554-8828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 052340) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |