MEDICARE: DR. ADRIENNE EMBRY AMMONS DDS

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

General Provider Information

NPI Number	:	1265578769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIENNE EMBRY AMMONS DDS

Provider Business Mailing Address
First Line	:	11349 TARA BLVD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-6261
Country	:	US
Telephone Number	:	678-619-2388
Fax Number	:	678-392-4420

Provider Business Practice Location Address
First Line	:	11349 TARA BLVD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-6261
Country	:	US
Telephone Number	:	678-619-2388
Fax Number	:	678-392-4420

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	06/19/2012

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