Healthcare Provider Details

I. General information

NPI: 1972732121
Provider Name (Legal Business Name): CHRISTIE BLECKLEY MCCARLEY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 08/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH STREET
AUGUSTA GA
30912
US

IV. Provider business mailing address

6295 HARLEM GROVETOWN RD.
HARLEM GA
30814
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2716
  • Fax:
Mailing address:
  • Phone: 706-577-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN013893
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: