| NPI | 1891393005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVRIL PATRICE DAISLEY SHONGO Provider 678-783-4860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2020-10-30 |