| NPI | 1821472077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM PHILLIP Credentialing Manager 770-985-4257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN183039) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |