| NPI | 1033481551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE PAYNE Practice Manager 912-826-4057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 043557) |
| 174400000X Specialist (Licence: SC MD26551) | |
| 208C00000X Colon & Rectal Surgery | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2021-07-06 |