| NPI | 1720396294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA LORRAINE ALLEN Case Manager 678-557-5873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: GA ac681128) |
| Enumeration Date | 2010-09-18 |
| Last Update Date | 2017-10-10 |