| NPI | 1366519530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN J. MADDOX Provider Enrollment COO Rdinator 912-350-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086X0206X Surgery Surgical Oncology |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-08-22 |