Medical school: WRIGHT STATE UNIVERSITY BOONSHOFT SCHOOL OF MEDICINE
Graduated: 1995
NPI: 1063470896
Practice Locations (1)
NORTHSIDE PRIMARY CARE PROFESSIONAL SERVICES,LLC
6000 HILLANDALE DR, SUITE 100
LITHONIA, GA 300584860
6784182120
Source: CMS National Downloadable File, September 2026.