Individual
DOMINIC MAISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3405 DALLAS HWY SW, MARIETTA, GA 30064-6425
(404) 990-3499
Mailing address
3651 MONTICELLO ST, DOUGLASVILLE, GA 30135-7721
(678) 557-0922
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH031110
GA
Other
Enumeration date
03/16/2022
Last updated
03/16/2022
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