Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jun 24, 2017
License(s)
5101023560 (MI), 085757 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 200 DOCTORS DR STE K | Douglas, GA 31533-2202 | 912-384-4024 |
| MAILING | PO BOX 1377 | Douglas, GA 31534-1377 | 912-384-1477 |
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