Facts
- Status
- A
- Credential
- D.C.
- Type
- Individual
- Enumeration date
- 2007-02-07
- Last updated
- 2007-07-08
Specialties
Licenses
- License GA
- CHIR007434
Location
- Practice location
- 3950 COBB PKWY NW, SUITE 106
- City
- ACWORTH GA
- Postal code
- 301019532
- Phone
- 770-966-8339
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.