| NPI | 1912291352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL A JOHNSON Owner 770-943-2525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014113) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2024-09-09 |