MEDICARE: O.W.A. MANAGEMENT SERVICES, LLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1417128497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O.W.A. MANAGEMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	3777 HIGHWAY 129 S
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-5823
Country	:	US
Telephone Number	:	706-219-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	3777 HIGHWAY 129 SOUTH
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-5823
Country	:	US
Telephone Number	:	706-219-0033
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. LYDIA D TURNER
Credential	:	R.D.H.
Telephone Number	:	706-219-0033

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/18/2008

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