| NPI | 1578937181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA G VON DER SCHULENBURG President 678-951-4576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 003997) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2015-11-19 |