| NPI | 1932651072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDTRICE RUSSELL Clinician 404-924-5560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA APC004555) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |