Registry details
Type
Individual
Primary specialty
Physician Assistant, Surgical
Enumerated
Jun 10, 2013
License(s)
006813 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1911 FAIRWAY CIR NE | Atlanta, GA 30319-3822 | 706-566-1715 |
| LOCATION | 2285 ASQUITH AVE SW | Marietta, GA 30008-6008 | 770-485-1554 |
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