| NPI | 1326144734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD G PETIT Physician's Assistant 770-277-8554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 001435) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-08-22 |