| NPI | 1558727289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUETTA CODY Manager, Provider Enrollment 404-785-7876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2023-03-28 |