| NPI | 1487365524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VENKAT DIVYA VANGALA Practice Manager 478-731-7235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2022-12-16 |