| NPI | 1972822062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE INGRAM Csa 770-354-6940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 3135) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2010-05-27 |