| NPI | 1366978991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON VIRDELL KING Owner/Director 678-517-3428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 051517853) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2021-11-24 |