Healthcare Provider Details

I. General information

NPI: 1932289881
Provider Name (Legal Business Name): HAROLD GRANGE RISH JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 JESSE HILL JR DR SE
ATLANTA GA
30303
US

IV. Provider business mailing address

99 JESSE HILL JR DR SE
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-730-1471
  • Fax: 404-730-1475
Mailing address:
  • Phone: 404-730-1471
  • Fax: 404-730-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9373
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: