| NPI | 1760856645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANETHA DEBORAH PETERSON Nurse Practitioner 678-464-9424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: GA 363L00000X) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2015-11-16 |