| NPI | 1861528689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES LOUIS BOUCHARD President 770-255-0434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD000418) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2014-02-25 |