| NPI | 1114317062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTY AQUINO Director Provider Enrollment 470-271-3427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery, Hand Surgery |
| 208VP0000X Pain Medicine, Pain Medicine | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2021-08-10 |