Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Sep 20, 2021
License(s)
6208 (SC), 11457 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 751649 | Charlotte, NC 28275-1649 | 888-472-0043 |
| LOCATION | 316 CALHOUN ST | Charleston, SC 29401-1113 | 843-720-8490 |
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