Registry details
Type
Individual
Primary specialty
Emergency Medicine
Enumerated
Jun 8, 2006
License(s)
16791 (SC), 39989 (GA), 16791 (SC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 4416 FOREST DR FL 2 | Columbia, SC 29206-3104 | 803-782-4278 |
| LOCATION | 70 MEDICAL CENTER DR | Commerce, GA 30529-1078 | 706-335-1000 |
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