| NPI | 1104831064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEIL EVAN GOODMAN President / Owner 912-554-0544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 034143) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: GA 034143) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2023-03-07 |