| NPI | 1073496253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAIRE D SHIVERS Practice Administrator 706-860-8228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-07-28 |
| Last Update Date | 2025-07-28 |