Individual
BON TRIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 532-7179
(770) 534-1312
Mailing address
PO BOX 1076, GAINESVILLE, GA 30503-1076
(770) 532-7179
(770) 534-1312
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
007291
GA
367H00000X
Anesthesiologist Assistant
Primary
7291
GA
Other
Enumeration date
09/22/2014
Last updated
02/01/2023
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