NPI | 1992468482 |
---|---|
Entity Type | Organization |
Authorized Contact | SANDRA JORDAN Provider Enrollment COO Rdinator 229-891-9131 |
Organization Subpart ? | No |
Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery |
Enumeration Date | 2021-10-21 |
Last Update Date | 2021-10-21 |