| NPI | 1982124020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL M. FULLER CEO/Community Service Provider 404-822-8842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2018-03-17 |