MADISON MANDULA BAZEMORE

GAINESVILLE, GA
NPI1306583323
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: GA  11992)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2022-05-20
Last Update Date2023-12-20
Business Address
MADISON MANDULA BAZEMORE PA
1315 JESSE JEWELL PKWY NE STE 300
GAINESVILLE, GA 30501-3875
Phone number: 770-848-6190
Mailing Address
MADISON MANDULA BAZEMORE PA
PO BOX 742616
ATLANTA, GA 30374-2616
Phone number: 770-219-8420