| NPI | 1831629948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY L LIKENS Owner 678-447-5439 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: GA 174148) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2021-11-10 |