Individual
JOSEPH VINCENT BAUTISTA DOROMAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
111 MOUNTAIN BROOK DR, CANTON, GA 30115-9045
(678) 880-9654
Mailing address
111 MOUNTAIN BROOK DR, CANTON, GA 30115-9045
(678) 880-9654
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN240795
GA
Other
Enumeration date
05/24/2018
Last updated
05/24/2018
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