| NPI | 1831766138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL E BANNISTER Owner 770-864-8423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2021-09-14 |