| NPI | 1568667624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FELICIA A WILSON Manager Cbo 678-514-2108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 208200000X Plastic Surgery |
| 2082S0105X Plastic Surgery, Surgery of the Hand | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2016-09-14 |