| NPI | 1487921581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY D BORAK Authorized Official 912-354-9447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2024-02-12 |