| NPI | 1891241758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKESHA COOPER Secretary 770-689-9565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 056706) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-08-31 |