Registry details
Type
Individual
Primary specialty
Podiatrist, Foot & Ankle Surgery
Enumerated
Jun 4, 2013
License(s)
036152796 (IL), 93218 (GA), U0545 (TX), 93218 (GA), 036152796 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 135 N PARK PL | Stockbridge, GA 30281-7209 | 770-892-0300 |
| MAILING | 135 N PARK PL | Stockbridge, GA 30281-7209 | 770-892-0300 |
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