| NPI | 1598914343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLON BRADFORD JACKSON Owner 404-681-3834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 9878) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2008-09-17 |