| NPI | 1629845680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTY AYCINENA Surgical First Assistant 678-858-1980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2024-05-15 |