| NPI | 1679942262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANEETA ANDERSON Certified Surgical Assistant 770-882-5276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2015-09-30 |