| NPI | 1851439830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONTEGO B BROOKS Office Manager 404-845-1219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 037308) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2020-08-22 |