| NPI | 1033424577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE DAVENPORT Office Manager 706-632-2085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 11866) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN009036) |
| 1223G0001X Dentist, General Practice (Licence: GA DN010761) | |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2010-08-09 |