FANTAUZZI, MARK RUDOLPH, DO
Medical - Physician
Georgia 043202 Surrendered
This Georgia license was held by FANTAUZZI, MARK RUDOLPH, DO. The license is no longer active. It was granted on 02/06/1997 and expired on 11/30/2012
LICENSE DETAILS
- License Number: 043202
- Category: Physician
- Status: Surrendered
- Date Granted: 02/06/1997 (over 28 years ago)
- Expiry Date: 11/30/2012 (over 12 years ago)
LOCATIONS
A Address
91 AUBURN STREET #J-1229 | C\O MEDLICENSURE PROF SVCS, LLC, PORTLAND 04103