| NPI | 1932563640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVERIL JOHNSON Manager 770-318-0476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 37708) |
| Additional Taxonomies | 207N00000X Dermatology |
| 207Q00000X Family Medicine (Licence: GA 38817) | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2020-01-16 |