Healthcare Provider Details

I. General information

NPI: 1730641473
Provider Name (Legal Business Name): ALLRED DENTISTRY GRIFFIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 S 8TH ST
GRIFFIN GA
30224-4818
US

IV. Provider business mailing address

743 S 8TH ST
GRIFFIN GA
30224-4818
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-6101
  • Fax:
Mailing address:
  • Phone: 770-228-6101
  • Fax: 770-228-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC BRANDON ALLRED
Title or Position: PARTNER OWNER/DENTIST
Credential: DMD
Phone: 770-228-6101