Healthcare Provider Details

I. General information

NPI: 1548596141
Provider Name (Legal Business Name): CAMPBELL ORAL SURGERY AND DENTAL IMPLANT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 WARM SPRINGS RD
COLUMBUS GA
31904-8029
US

IV. Provider business mailing address

1818 WARM SPRINGS RD
COLUMBUS GA
31904-8029
US

V. Phone/Fax

Practice location:
  • Phone: 877-705-0001
  • Fax: 888-878-2118
Mailing address:
  • Phone: 877-705-0001
  • Fax: 888-878-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10762
License Number StateGA

VIII. Authorized Official

Name: LINDA ABERNATHY
Title or Position: BUSINESS OFFICE DIRECTOR
Credential:
Phone: 877-705-0001