Graduated: 2014
NPI: 1336118660
Practice Locations (2)
THE SOUTHEAST PERMANENTE MEDICAL GROUP
3495 PIEDMONT RD NE
ATLANTA, GA 303051729
4043647206
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
6104 OLD BRANCH AVE
TEMPLE HILLS, MD 207482518
3017026100
Source: CMS National Downloadable File, September 2026.