| NPI | 1851468862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEBRENA HOLMES GIBSON Provider Enrollment COO Rdinator 912-350-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2016-10-14 |