| NPI | 1053550186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE BLACKMON Credentialing Specialist 770-748-0309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 030690) |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2010-01-05 |