Individual
AMANDA BOSTOCK SOWISDRAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
250 PARKBROOKE PL STE 300, WOODSTOCK, GA 30189
(770) 442-1911
Mailing address
PO BOX 1093, WOODSTOCK, GA 30188-1093
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/12/2017
Last updated
01/14/2019
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