| NPI | 1912019308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALESHA HERRING Practice Manager 912-287-1130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 4309190001) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-02-18 |