| NPI | 1639704307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK PAUL TANNER Certified Surgical Assistant 678-516-2119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2020-03-03 |