Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2017-05-12
- Last updated
- 2024-06-28
Specialties
Licenses
- License GA
- 89819
Location
- Practice location
- 2200 DULUTH HIGHWAY 120 APT 4007
- City
- DULUTH GA
- Postal code
- 300974156
- Phone
- 706-414-2502
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.