| NPI | 1942307160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER S GROSS Owner 770-781-5077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 030078) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 003130) |
| 363L00000X Nurse Practitioner (Licence: GA RN164556) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-09-28 |