| NPI | 1982072609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TELITA ANTHONY Certified First Surgical Assist 770-905-3089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2016-02-26 |