| NPI | 1912029687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA DAWN COOPER Office Manager 912-265-4766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2014-10-31 |