| NPI | 1770949497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUETTA CODY Mgr, Provider Enrollment 404-785-7876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 2080S0010X Pediatrics, Sports Medicine | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 2086S0120X Surgery, Pediatric Surgery | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery | |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2023-02-23 |