| NPI | 1710155445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY BURKE Office Manager 770-482-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 11497) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2008-02-15 |