Individual
JEFF A D'AMBROSIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
215 RIVERSTONE DR, CANTON, GA 30114-5256
(770) 345-6600
(770) 345-6611
Mailing address
215 RIVERSTONE DR, CANTON, GA 30114-5256
(770) 345-6600
(770) 345-6611
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004621
GA
Other
Enumeration date
06/05/2007
Last updated
07/08/2007
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