| NPI | 1710236880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELANIA W MILES Office Manager 678-715-2993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 041745) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2012-09-05 |