| NPI | 1811291149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY KATHRYN GEPHART Owner/Physician 4040-806-3731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001122) |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2015-08-14 |