Individual
JONATHAN P CORLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4100 EMBASSY DR SE, SUITE 200, GRAND RAPIDS, MI 49546-2416
(616) 975-1845
Mailing address
224 PECAN PARK AVE, ALEXANDRIA, LA 71303-3308
(318) 427-7900
(318) 427-7901
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
LA
Other
Enumeration date
07/17/2012
Last updated
07/24/2012
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