| NPI | 1912149907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN J MADDOX Provider Enrollment COO Rdinator 912-350-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2011-05-03 |