Graduated: 2001
NPI: 1164774543
Practice Locations (2)
VITAE HEALTH MEDICAL GEORGIA LLC
2722 N DECATUR RD
DECATUR, GA 300335910
4042965440
LIFESOURCE OF NORTH CAROLINA
1345 REDMOND CIR NW
ROME, GA 301651307
9107429243
Source: CMS National Downloadable File, September 2026.