| NPI | 1750124483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TENNILLE MORRIS HICKS Family Nurse Practitioner/ Owner 678-789-0762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2024-06-19 |