| NPI | 1932589892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON DANANE LIVINGSTON Practice Manager 404-292-4223 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 031531) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2015-06-05 |