| NPI | 1720218795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW LOUIS SMITH Licensed Psychologist 678-849-5688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 003247) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2009-07-23 |