Medical school: KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE
Graduated: 1988
NPI: 1275643710
Practice Locations (2)
MYSTIC MEDICAL LLC
5555 GLENRIDGE CONNECTOR, SUITE 200
ATLANTA, GA 303424815
4044592516
1276 MERRY ST
AUGUSTA, GA 309043845
7063734402
Source: CMS National Downloadable File, September 2026.