| NPI | 1336463876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA ANNE MASCUNANA Office Manager 912-356-3604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 031202) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2010-03-25 |