| NPI | 1497061287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTHA B BOONE Owner 404-705-8366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 42408) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 042408) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2015-02-20 |