Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jan 17, 2006
License(s)
MD2017-0772 (NM), 25MA06877100 (NJ), 101139 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1525 CLIFTON RD. NE 1ST FLOOR, SUITE 105 | Atlanta, GA 30322 | 616-717-3082 |
| MAILING | 1525 CLIFTON RD NE STE 1051 | Atlanta, GA 30322-4200 | 616-717-3082 |
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