NPI | 1912342197 |
---|---|
Entity Type | Organization |
Authorized Contact | CHARMAINE ANTONIA HERMAN CFO/Doctor 678-393-8833 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 008584) |
Enumeration Date | 2013-05-01 |
Last Update Date | 2013-05-01 |