Healthcare Provider Details

I. General information

NPI: 1801900360
Provider Name (Legal Business Name): ROBERT J. MCGEE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JARRETT DR
LEESBURG GA
31763-4735
US

IV. Provider business mailing address

101 JARRETT DR
LEESBURG GA
31763
US

V. Phone/Fax

Practice location:
  • Phone: 229-432-6012
  • Fax: 229-438-8663
Mailing address:
  • Phone: 229-432-6012
  • Fax: 229-438-8663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10699
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: