| NPI | 1942770599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERVIN LYNN WILSON Director 404-748-8255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2018-11-27 |