| NPI | 1669185468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA S BASS President 678-284-9050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology |
| 261QV0200X Clinic/Center, VA | |
| Enumeration Date | 2022-12-27 |
| Last Update Date | 2024-01-24 |