| NPI | 1336477934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE LILLICOTCH Credentialing Officer 478-272-2255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0001X |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2012-10-02 |