MADISON MANDULA BAZEMORE PA
Individual Provider (NPI-1)
Active
Physician Assistant
Provider Information
- NPI Number
1306583323- Provider Type
- Individual Provider (NPI-1)
- Credentials
- PA
- Status
- Active
Contact & Location
- Address
- 1315 JESSE JEWELL PKWY NE STE 300, GAINESVILLE, GA, 305013875
- Phone
- (770) 848-6190
Specialties & Taxonomies
Student in an Organized Health Care Education/Training Program
Physician Assistant
Primary License: GA #11992