| NPI | 1083394266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERICA NICOLE SAMS Owner/ Authorized Official 706-340-4330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2024-09-04 |