| NPI | 1952143562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RECHELLE TULL Owner 706-218-1724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Additional Taxonomies | 207N00000X Dermatology |
| 207NS0135X Dermatology, Procedural Dermatology | |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2024-09-24 |