Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jul 18, 2017
License(s)
MD61224149 (WA), RL14599 (ND), 95698 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 73 MAXWELL LN | Dahlonega, GA 30533-7146 | 770-219-9630 |
| MAILING | PO BOX 742616 | Atlanta, GA 30374-2616 | 770-219-8420 |
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