| NPI | 1437363587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA EDWARD LANE Provider/President 706-322-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2023-03-15 |