Individual
MISS DEIDRA DYAN MUNSANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12201 HIGHWAY 92 STE D, WOODSTOCK, GA 30188
(770) 517-4621
Mailing address
805 SANDY PLAINS ROAD, MEDICAL STAFF SERVICES, MARIETTA, GA 30066-6340
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1937
OK
363A00000X
Physician Assistant
Primary
—
GA
Other
Enumeration date
12/15/2010
Last updated
11/06/2019
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