| NPI | 1821537655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY EARL JACOBS Owner 770-282-9860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 305R00000X) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2017-02-13 |