Graduated: 1994
NPI: 1417129339
Practice Locations (2)
THE SOUTHEAST PERMANENTE MEDICAL GROUP
3495 PIEDMONT RD NE
ATLANTA, GA 303051729
4043647206
GOOD SHEPHERD HEALTH CARE SYSTEM
610 NW 11TH ST
HERMISTON, OR 978386601
5416673400
Source: CMS National Downloadable File, September 2026.