| NPI | 1558625319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES DAVID FOREMAN Physician Assistant 678-462-9734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 003373) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2013-05-13 |