| NPI | 1982288536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG PRIDGEN Authorized Official 678-203-1323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2021-08-11 |