Healthcare Provider Details

I. General information

NPI: 1922252956
Provider Name (Legal Business Name): SUZANNE HOLLINGSWORTH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38717 38TH STREET USA DENTAC
FT GORDON GA
30905-5660
US

IV. Provider business mailing address

38717 38TH STREET USA DENTAC
FT GORDON GA
30905-5660
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-7050
  • Fax:
Mailing address:
  • Phone: 706-787-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: