| NPI | 1689036949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA PEARSON Om 770-377-8874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 053715) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: GA 053715) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2016-03-25 |