person
Mrs. Mary M Domville, PA
Medical Physician Assistant in Carrollton, Georgia
NPI 1578573820

Mary M Domville is a Medical Physician Assistant based in Carrollton, GA and is specialized in Medical. Mary M Domville practices in Carrollton, GA and has the professional credentials of PA. The NPI Number for Mary M Domville is 1578573820 and holds a License No. 003494 (Georgia).

The current practice location address for Mary M Domville is 524 Dixie St, Carrollton, GA and can be reached out via phone at 770-832-2775.

Location: 524 Dixie St, Carrollton, GA, 30117-3805
person
Provider Profile Details
NPI Number
1578573820
Provider Name
Mary M Domville
Credential
PA
Provider Entity Type
Individual
Gender
Female
Address
524 Dixie St, Carrollton, GA, 30117-3805
Phone Number
770-832-2775
Fax Number
Provider Enumeration Date
08/09/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
003494 01 GA STATE LICENSE
institution
Provider Business Practice Location Address Details
Address
524 Dixie St
City
State
Zip
30117-3805
Phone Number
770-832-2775
Fax Number
person
Provider Business Mailing Address Details
Address
524 Dixie St
City
State
Zip
30117-3805
Phone Number
770-832-2775
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
003494 (Georgia)
Definition
Definition to come...
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