| NPI | 1992534895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL GEORGE SHANINE Practice Manager 470-684-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2024-07-29 |