Healthcare Provider Details

I. General information

NPI: 1386052363
Provider Name (Legal Business Name): JOHN D. WELCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2556 APPLE VALLEY RD NE SUITE 150
ATLANTA GA
30319-5425
US

IV. Provider business mailing address

2556 APPLE VALLEY RD NE SUITE 150
ATLANTA GA
30319-5425
US

V. Phone/Fax

Practice location:
  • Phone: 404-467-0890
  • Fax: 404-467-0872
Mailing address:
  • Phone: 404-467-0890
  • Fax: 404-467-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number011328
License Number StateGA

VIII. Authorized Official

Name: DR. JOHN DAVID WELCH
Title or Position: OWNER
Credential: DDS
Phone: 404-467-0890