| NPI | 1609994136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE S INNISS Office Manager 770-760-7566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA dn012791) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |