Individual
IRINA SIDORENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2311 RIDGE FOREST DR, GRAYSON, GA 30017-1718
(678) 656-6819
Mailing address
2311 RIDGE FOREST DR, GRAYSON, GA 30017-1718
(678) 656-6819
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
20299
GA
363AS0400X
Surgical Physician Assistant
Primary
20-299
GA
Other
Enumeration date
07/21/2020
Last updated
11/19/2021
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