| NPI | 1003915372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY WELDON Office Manager 706-494-8375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 026200) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 00006971) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2012-01-28 |