| NPI | 1841619269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATINA LAC KHAN Owner 770-978-9696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: GA 14000773) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2022-11-01 |