| NPI | 1740334291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUETTA CODY Manager, Provider Enrollment 404-785-7876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 367500000X Nurse Anesthetist, Certified Registered | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-03-28 |