| NPI | 1972807865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY C LEACH Billing/Collection Supervisor 678-736-6342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 006247) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: GA 000186) |
| 207Q00000X Family Medicine (Licence: GA 038861) | |
| 208D00000X General Practice (Licence: GA 038861) | |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2011-01-06 |