| NPI | 1720432891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON SELENA DUNCAN Credentialing Specialist 678-656-7203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 52304) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2016-04-15 |