| NPI | 1073076170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH MAYNOR Credentialing Coordinator 770-477-9535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2019-04-08 |