| NPI | 1720540628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN VAUGHN Officer 404-450-4684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-09-25 |