| NPI | 1407371768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI RYBAK Certified Surgical First Assistant 770-331-4217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2022-07-21 |