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Individual

DR. W. JEFFERSON PENDERGRAST JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2505 FLAIR KNOLL CT NE, ATLANTA, GA 30345-1311
(404) 636-2332
Mailing address
2505 FLAIR KNOLL CT NE, ATLANTA, GA 30345-1311
(404) 636-2332

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
015409
GA

Other

Enumeration date
12/12/2006
Last updated
04/14/2011
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