| NPI | 1316324932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY JOHNSON Dds 770-405-8707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN008043) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2015-05-04 |