| NPI | 1710352992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEIDRA BLANKS Physician 910-840-3093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 207N00000X Dermatology | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery | |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |