| NPI | 1972125847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON CY GRINAGE Medical Director 770-580-0979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 261QI0500X Clinic/Center, Infusion Therapy | |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2024-09-08 |