| NPI | 1861820995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAHANN VAUGHN Managed Care Coordinator 770-822-4245 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2013-10-29 |