| NPI | 1073975868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA L WEBB Office Manager 706-882-0591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN008745) |
| 122300000X Dentist (Licence: GA DN014796) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2016-03-22 |