Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Jan 14, 2011
License(s)
4694 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 107 CARLYLE LK | Decatur, GA 30033-4614 | |
| LOCATION | 107 CARLYLE LK | Decatur, GA 30033-4614 | 404-805-9125 |
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.