| NPI | 1417408964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY KAE JETTON CEO 770-842-1907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 1256) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-12-12 |