| NPI | 1902003841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES BRUCE MOOMEY Owner 770-962-9977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 049923) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2010-09-01 |