| NPI | 1972712362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERT D JOLLEY President 770-254-8787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 11218) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-08-22 |