| NPI | 1740501246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH STAATS Office Administrator 770-461-5003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 17642) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2010-06-18 |