Healthcare Provider Details

I. General information

NPI: 1497261960
Provider Name (Legal Business Name): ROCKWELL ORAL AND FACIAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N. HIGHLAND AVE NE SUITE 100
ATLANTA GA
30306
US

IV. Provider business mailing address

675 N. HIGHLAND AVE NE SUITE 100
ATLANTA GA
30306
US

V. Phone/Fax

Practice location:
  • Phone: 678-732-9413
  • Fax: 404-500-5483
Mailing address:
  • Phone: 678-732-9413
  • Fax: 404-500-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. DAMION ROCKWELL
Title or Position: ORAL AND MAXILLOFACIAL SURGEON
Credential: DMD
Phone: 229-392-3897