| NPI | 1366513988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN NATHAN BENNETT Physician 706-312-3668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: GA POD000842) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2019-07-03 |