| NPI | 1942757547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH DELANE MAGEE Owner 678-462-5628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS 1226) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |