MEDICARE: DR. DENT W. PURCELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	GA 12545	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023019338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENT W. PURCELL M.D.

Provider Business Mailing Address
First Line	:	2864 JOHNSON FERRY RD
Second Line	:	SUITE 150
City	:	MARIETTA
State	:	GA
Zip	:	30062-5635
Country	:	US
Telephone Number	:	770-693-2622
Fax Number	:	770-693-6039

Provider Business Practice Location Address
First Line	:	410 WILLOWPEG WAY
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-9157
Country	:	US
Telephone Number	:	912-826-5465
Fax Number	:	912-826-4851

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/19/2007

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Directions to “ DR. DENT W. PURCELL M.D.” Practice Location

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