Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Nov 30, 2005
License(s)
02963 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1597 LANCASTER DR | Marietta, GA 30066-5915 | 770-218-9195 |
| LOCATION | 1670 CLAIRMONT RD | Decatur, GA 30033-4004 | 404-321-6111 |
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