| NPI | 1447376660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERENCE MALLOY MARTIN Owner 478-743-4321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 000239) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-08-22 |