| NPI | 1063651719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOFIA KHAN Cma, Office Manager 678-380-8353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 1077186) |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2009-02-19 |