Individual
DI CUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
59 EXECUTIVE PARK S, #2000, ATLANTA, GA 30329-2208
(404) 778-7138
Mailing address
59 EXECUTIVE PARK S, #2000, ATLANTA, GA 30329-2208
(404) 778-7138
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
69789
GA
Other
Enumeration date
04/02/2009
Last updated
12/13/2013
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