| NPI | 1679616072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA ROSIER CREWSONBERRY Billing Manager 706-738-1925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD000710) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2008-06-18 |