| NPI | 1801920301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE LIEUPO CARTER Administrator 912-352-2324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 204E00000X Oral & Maxillofacial Surgery | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2022-07-21 |