Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
May 8, 2020
License(s)
2023027653 (MO), 104069 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1199 PRINCE AVE | Athens, GA 30606-2797 | |
| LOCATION | 1199 PRINCE AVE | Athens, GA 30606-2797 | 706-475-7000 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.