| NPI | 1871051474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ROSE HALE Director Of Credentialing 770-874-5439 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2019-03-04 |