| NPI | 1043411648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUDHAKAR JONNALAGADDA Officer 912-384-7276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 034-295) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2022-05-19 |