| NPI | 1699429027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHO GLADNEY Owner 470-925-6802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| 208D00000X General Practice | |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2022-02-04 |