| NPI | 1669736120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN C WEBER Owner 770-214-9146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 052922) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: GA CHIR007565) |
| 363LF0000X Nurse Practitioner Family (Licence: GA RN148627) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2012-06-29 |