Individual
MS. IRENE RISTIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
902 ATHENS HWY, LOGANVILLE, GA 30052-4904
(770) 554-5533
(770) 554-8129
Mailing address
225 MAYFIELD FARMS DR, LAWRENCEVILLE, GA 30043-6161
(770) 271-2654
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
037660
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00572448B
—
GA
Enumeration date
01/29/2007
Last updated
05/30/2012
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