| NPI | 1790875037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA HERNANDEZ Executive Director 770-219-8420 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| 207QS0010X Family Medicine, Sports Medicine | |
| 207R00000X Internal Medicine | |
| 208D00000X General Practice | |
| 261QU0200X Clinic/Center, Urgent Care | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2023-05-16 |