Individual
ALAN STANLEY DOMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2860 RONALD REAGAN BLVD STE 240, CUMMING, GA 30041-6289
(404) 355-0743
(855) 283-8851
Mailing address
2860 RONALD REAGAN BLVD STE 240, CUMMING, GA 30041-6289
(404) 355-0743
(855) 283-8851
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9678
GA
363A00000X
Physician Assistant
Primary
PA9110804
FL
Other
Enumeration date
10/05/2017
Last updated
07/06/2026
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