Medical school: UNIVERSITY OF CHICAGO, PRITZKER SCHOOL OF MEDICINE
Graduated: 1984
NPI: 1366440992
Practice Locations (1)
NORTHSIDE SURGICAL PROFESSIONAL SERVICES LLC
2200 MEDICAL CTR BLVD, SUITE 340
LAWRENCEVILLE, GA 300467768
7709780561
Source: CMS National Downloadable File, September 2026.