| NPI | 1073153409 |
|---|---|
| Other Name | R01 MOUNT VERNON |
| Entity Type | Organization |
| Authorized Contact | KERI LANIADO Accountant 678-701-2225 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2020-01-14 |