| NPI | 1891856167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE STEPHEN GILLIAM Owner President 270-691-9697 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KY 22817) |
| Additional Taxonomies | 208600000X Surgery |
| 246Z00000X Specialist/Technologist, Other | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-02-28 |