| NPI | 1811420581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIE LYNN TANNER Owner/Officer 678-465-9414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2017-04-09 |