| NPI | 1255700092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERROD LAQUINTON WILLIAMS Owner 404-932-0295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: DC 2610) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2025-12-05 |