Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jul 26, 2005
License(s)
003405 (NY), 13115 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 1213 | Brunswick, GA 31521-1213 | 912-466-5000 |
| LOCATION | 2500 STARLING ST STE 602 | Brunswick, GA 31520-4271 | 912-466-4669 |
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