| NPI | 1588842686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES J SIDLOW Podiatrist 770-386-1389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 0508570001) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2012-12-18 |