| NPI | 1689683187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVETTA LAVERN BORDEN Owner 912-876-8637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: GA POD000770) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA POD000770) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2009-02-09 |