Medical school: MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Graduated: 1996
NPI: 1346215837
Practice Locations (2)
3692 HIGHLANDS PKWY SE
SMYRNA, GA 300825184
3692 HIGHLANDS PKWY SE, BLDG 2
SMYRNA, GA 300825184
7704312322
Source: CMS National Downloadable File, September 2026.