| NPI | 1326208893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY T. ELLIS Insurance Clerk 706-546-7908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: GA 10908) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2009-03-31 |