| NPI | 1750525515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE IVIE EJAIFE-AUSTIN Podiatrist 678-360-7939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001084) |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2009-04-23 |