| NPI | 1215306295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE INGRAM Certified Surgical Assistant 770-354-6940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2015-09-19 |
| Last Update Date | 2022-05-10 |