| NPI | 1992353312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY HARRING Credentialing/ Billing 678-761-5956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2020-01-22 |