| NPI | 1952796484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN FAGAN Owner/Md 706-863-9595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2022-10-11 |