| NPI | 1679005557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN A. FULLER President 770-740-0895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2017-05-09 |