| NPI | 1972915395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENA ADRIANA CASTILLO Physician Assistant 770-771-5600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 7131) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2014-05-21 |