Registry details
Type
Individual
Primary specialty
Physician Assistant, Surgical
Enumerated
Oct 16, 2015
License(s)
55-004485 (OH), 9222 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 61 WHITCHER ST NE STE 4100 | Marietta, GA 30060 | 770-590-4180 |
| MAILING | 61 WHITCHER ST NE STE 4100 | Marietta, GA 30060-1181 | 770-590-4180 |
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