| NPI | 1740997675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEROCKO RIESHELL GATLING-JAMES Business Owner 770-807-4710 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QI0500X Clinic/Center, Infusion Therapy | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2025-06-03 |