| NPI | 1861933582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES PITTS Owner 706-884-3263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA GAD009828) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |