| NPI | 1396196812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH J. HENDERSON Office Manager 912-355-2688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN013747) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2016-06-27 |