Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Apr 26, 2023
License(s)
12728 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 882 PONCE DE LEON AVE NE # 2330 | Atlanta, GA 30306-4268 | 770-809-3034 |
| MAILING | 1220 MECASLIN ST NW APT 2330 | Atlanta, GA 30318-5656 | 704-648-1872 |
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