| NPI | 1821244187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY ASANTE Administrator 706-576-6844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA 000628) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 000628) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: GA 000628) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: GA 000628) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2012-05-17 |