| NPI | 1760062780 |
|---|---|
| Former Legal Business Name | PROACTIVE MD GA, LLC |
| Entity Type | Organization |
| Authorized Contact | MARK ALLEN KEMBLE Chief Medical Officer 864-640-8355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2026-01-27 |