| NPI | 1568044758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEYANNA CONYERS Director Of Credentialing 678-680-4945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 208VP0000X Pain Medicine, Pain Medicine | |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2024-06-04 |