| NPI | 1154897981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA VON DER SCHULENBURG Owner/President 678-951-4576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2018-10-19 |