Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Dec 26, 2012
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 510 N HALE ST | Southern Pines, NC 28387-4013 | 910-273-3225 |
| LOCATION | HSC 6TH BN 2D SFAB BLDG H-5626 | Fort Bragg, NC 28310-0001 | 910-273-3225 |
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.