| NPI | 1952518698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN STAPLETON Practice Administrator 770-474-0064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 105947) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2010-08-30 |