| NPI | 1962964833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLA MCMEANS Sys Dir Of Credentialing 706-494-3171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363A00000X Physician Assistant | |
| 207QS0010X Family Medicine, Sports Medicine | |
| 2085R0202X Radiology, Diagnostic Radiology | |
| 207R00000X Internal Medicine | |
| 363AS0400X Physician Assistant, Surgical | |
| 231H00000X Audiologist | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-12-11 |