Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Dec 8, 2005
License(s)
36443 (IA), 36443 (IA), A96265 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 2779 | Covington, GA 30015-7779 | 770-385-7993 |
| LOCATION | 5126 HOSPITAL DR NE | Covington, GA 30014-2566 | 770-385-7993 |
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