| NPI | 1134682859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM JEADEMANN Practice Administrator 770-664-6533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2019-04-09 |