| NPI | 1619017001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN JONES MAILEY Office Manager 678-990-5980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA ga9997) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA ga8077) |
| 122300000X Dentist (Licence: GA dn12408) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-08-22 |