| NPI | 1316165723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA MARIE BOCKHORST Practice Administrator 770-425-0118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2022-07-21 |