| NPI | 1669848388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L DORGAN Treasurer 770-667-0099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2015-08-17 |