| NPI | 1528628401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMONIA LEONARD Credentialing Specailst 678-244-4844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2019-07-18 |