| NPI | 1972853638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN M CLARK Doctor/Owner 678-438-4225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA LPC005485) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2012-09-10 |