Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Nov 25, 2006
License(s)
004894 (GA), 4894 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1484 TETHER LN | Mcdonough, GA 30253-9210 | |
| LOCATION | 1412 MILSTEAD AVE NE | Conyers, GA 30012-3877 | 404-605-2800 |
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