| NPI | 1215482765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMMY LEE BLOUNT Owner 678-342-9933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DNO11497) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2016-08-31 |