| NPI | 1518472299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCELLA ANN TOWNSEND Certified Surgical Assistant 912-604-0905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2023-07-31 |