| NPI | 1659893139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES BRADFORD DEPEW Owner 678-752-7842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 078473) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2026-03-27 |