| NPI | 1912211129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTY AQUINO Director, Provider Enrollment 470-895-0214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 363L00000X Nurse Practitioner (Licence: GA RN115077) | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2023-04-11 |