MEDICARE: ADRIENNE EMBRY AMMONS, D.D.S., P.C.

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	1223G0001X	General Practice Dentistry	DN013238	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1265578769	OTHER	GA	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1154688471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADRIENNE EMBRY AMMONS, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	11349 TARA BLVD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-6261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11349 TARA BLVD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-6261
Country	:	US
Telephone Number	:	678-964-2148
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. ADRIENNE EMBRY AMMONS
Credential	:	DDS
Telephone Number	:	678-964-2148

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/12/2012

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