Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jan 17, 2026
License(s)
0110011620 (VA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 749112 | Atlanta, GA 30374-9112 | 434-295-1000 |
| LOCATION | 1215 LEE ST | Charlottesville, VA 22908-0816 | 434-924-2706 |
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