Healthcare Provider Details

I. General information

NPI: 1447395173
Provider Name (Legal Business Name): PATRICIA WELLBORN HAMPTON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA CAROL WELLBORN DMD

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5490 MARTHA BERRY HWY NE
ARMUCHEE GA
30105-2302
US

IV. Provider business mailing address

PO BOX 175
ARMUCHEE GA
30105-0175
US

V. Phone/Fax

Practice location:
  • Phone: 706-292-0777
  • Fax: 706-292-9428
Mailing address:
  • Phone: 706-292-0777
  • Fax: 706-292-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN010255
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: