Healthcare Provider Details

I. General information

NPI: 1326207440
Provider Name (Legal Business Name): KENNETH WAYNE SPRAGGINS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 JESSE HILL JR DR SE THIRD FLOOR - DENTAL DEPARTMENT
ATLANTA GA
30303-3030
US

IV. Provider business mailing address

99 JESSE HILL JR DR SE THIRD FLOOR - DENTAL DEPARTMENT
ATLANTA GA
30303-3030
US

V. Phone/Fax

Practice location:
  • Phone: 404-730-1476
  • Fax: 404-730-1475
Mailing address:
  • Phone: 404-730-1476
  • Fax: 404-730-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number7643
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: