| NPI | 1952599516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DINA J GORE Medical Billing & Insurance Manager 770-343-9112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 2401782) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 2401782) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2013-01-17 |