| NPI | 1073028866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONE MALLOY CEO/Owner 404-630-5573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 23086) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 23086) |
| Enumeration Date | 2017-12-03 |
| Last Update Date | 2017-12-03 |