| NPI | 1396094074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DURWOOD M JOHNSON Doctor 770-461-2101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: GA 007973) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2013-05-10 |