| NPI | 1972005155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA DIOUF CEO 404-615-5551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2022-04-06 |