Organization
URBAN TEMPLE STUDIO 107
Active
Organization subpart
No
Provider details
NPI number
Authorized official
QIANA L GORDON LMT (OWNER)
(404) 600-5624
Entity
Organization
Contact information
Practice address
1867 LAWRENCEVILLE HWY, DECATUR, GA 30033-5729
(404) 600-5624
Mailing address
1867 LAWRENCEVILLE HWY, DECATUR, GA 30033-5729
(404) 600-5624
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
007007
GA
Other
Enumeration date
07/11/2013
Last updated
07/11/2013
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