| NPI | 1811266646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDDIE P JOHNSON Dentist 706-790-9179 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 009685) |
| Enumeration Date | 2011-12-23 |
| Last Update Date | 2011-12-23 |