Organization
MASTERPIECEWITHIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORETTA JOHNSON MCCLEE (OWNER)
(678) 913-9169
Entity
Organization
Contact information
Practice address
2164 HIDDEN GLEN DR SE, MARIETTA, GA 30067-8740
(678) 913-9169
Mailing address
2164 HIDDEN GLEN DR SE, MARIETTA, GA 30067-8740
(678) 913-9169
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
CL1230175
FL
Other
Enumeration date
11/26/2013
Last updated
11/26/2013
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