| NPI | 1144823766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA S JACKSON Contract, Cred & Benefits Mgr 770-446-8000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 1223E0200X Dentist, Endodontics | |
| 1223G0001X Dentist, General Practice | |
| 1223P0700X Dentist, Prosthodontics | |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2020-11-17 |