| NPI | 1780725127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH A ROUSE Owner 912-355-6503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA 885) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA 973) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2016-07-19 |