| NPI | 1962777235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE ANNE RODRIGUEZ Billing Manager 678-541-0777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation |
| 225100000X Physical Therapist | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2016-06-16 |