Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Sep 4, 2012
License(s)
74880 (GA), 74880 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 742616 | Atlanta, GA 30374-2616 | 770-219-8420 |
| LOCATION | 1255 HIGHWAY 54 W | Fayetteville, GA 30214-4526 | 770-719-5630 |
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