Individual
LAN LEI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(530) 424-8285
Mailing address
2992 HARTFORD MILL PL, DULUTH, GA 30097-7671
(631) 371-7870
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12746
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
GA
Other
Enumeration date
03/24/2021
Last updated
02/19/2024
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