Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Jul 14, 2014
License(s)
7214 (GA), 7214 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1515 RIVER PL STE 100 | Braselton, GA 30517-5610 | 770-848-6195 |
| MAILING | PO BOX 742616 | Atlanta, GA 30374-2616 | 770-219-8420 |
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