| NPI | 1669769063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE B. LANE Office Admin 404-564-4985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 251s00000x) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2011-10-07 |