Registry details
Type
Individual
Primary specialty
Anesthesiology
Enumerated
Jan 25, 2006
License(s)
25MA07588900 (NJ)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 804 SCOTT NIXON MEMORIAL DR | Augusta, GA 30907-2464 | |
| LOCATION | 225 WILLIAMSON ST | Elizabeth, NJ 07202-3625 | 908-994-5204 |
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.