Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Jun 14, 2006
License(s)
2010-00067 (NC), 2010-00067 (NC), 101009860 (MI), 1823 (TN), 60148 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 402 ADAMSON SQUARE STE 6 | Carrollton, GA 30117-1816 | 700-836-1178 |
| MAILING | 402 ADAMSON SQUARE STE 6 | Carrollton, GA 30117-1816 | 770-836-1178 |
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