| NPI | 1154568582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE MARIE CLOUS Podiatrist 770-852-7035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: GA POD001011) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: GA POD001011) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2014-11-19 |