Individual
RADA PAVENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
424 EAGLE TIFF DR, SUGAR HILL, GA 30518-7101
(678) 200-2903
Mailing address
424 EAGLE TIFF DR, SUGAR HILL, GA 30518-7101
(678) 200-2903
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
190469
—
Other
Enumeration date
09/13/2024
Last updated
10/21/2024
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