| NPI | 1932600491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUANITA DAVIS Owner 678-680-9558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 16100292) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2018-03-17 |