| NPI | 1962957605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RASEAN HODGE Owner/Partner 770-256-7033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X (Licence: GA 054221) |
| 261QI0500X Clinic/Center, Infusion Therapy (Licence: GA 054221) | |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2016-08-23 |