| NPI | 1063682680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD O MOSLEY President 912-537-4119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: GA 01415) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2008-03-11 |