Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Oct 31, 2016
License(s)
304168 (LA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | DEPT 952639 | Atlanta, GA 31192-2639 | |
| LOCATION | 5000 HENNESSY BLVD | Baton Rouge, LA 70808-4375 | 225-926-8686 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.