| NPI | 1740922640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB SUNG KEUM Attending Physician 770-876-9602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2022-04-20 |