MEDICARE: MARY CAROLINE JARRELL DMD

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	1223P0221X	Pediatric Dentistry	DN014491	GA

General Provider Information

NPI Number	:	1598030884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CAROLINE JARRELL DMD

Provider Business Mailing Address
First Line	:	2570 BROOKSTONE CENTRE PKWY
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	GA
Zip	:	31904-4669
Country	:	US
Telephone Number	:	706-327-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	2570 BROOKSTONE CENTRE PKWY
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	GA
Zip	:	31904-4669
Country	:	US
Telephone Number	:	843-513-3909
Fax Number	:

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

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	10/30/2017

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