Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Jan 25, 2018
License(s)
10346 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 742616 | Atlanta, GA 30374-2616 | 770-219-8420 |
| LOCATION | 200 S ENOTA DR NE STE 480 | Gainesville, GA 30501-3473 | 770-534-2020 |
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