Graduated: 1995
NPI: 1003853847
Practice Locations (2)
THE SOUTHEAST PERMANENTE MEDICAL GROUP
3495 PIEDMONT RD NE
ATLANTA, GA 303051729
4043647206
THE SOUTHEAST PERMANENTE MEDICAL GROUP
101 BANKS STA
FAYETTEVILLE, GA 302147507
4043796148
Source: CMS National Downloadable File, September 2026.