Individual
MS. RAINA UDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
5470 MEMORIAL DR, STE A, STONE MOUNTAIN, GA 30083-3268
(404) 296-8500
Mailing address
5470 MEMORIAL DR, STE A, STONE MOUNTAIN, GA 30083-3268
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6417
GA
Other
Enumeration date
05/13/2013
Last updated
05/13/2013
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