| NPI | 1891199659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANEKA GLOVER Provider Enrollment Coordinator 404-941-1241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD072843L) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2014-10-22 |