| NPI | 1679777932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERMAINE D. CUMMINGS Medical Doctor 770-955-3501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 121406) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2020-08-22 |