Individual
IAN JAMES MUKISA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
DWIGHT DAVID EISENHOWER ARMY MEDICAL CENTER, 300 EAST HOSPITAL ROAD, FORT GORDON, GA 30909-5650
(631) 568-1009
(706) 787-1745
Mailing address
300 EAST HOSPITAL ROAD, FORT GORDON, GA 30909-5650
(706) 787-1745
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
GA
Other
Enumeration date
11/01/2019
Last updated
03/24/2021
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