| NPI | 1679217426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY L PRIDGEN Managingmember/Clinical COO Rdinator 470-418-4263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2022-04-26 |