Healthcare Provider Details

I. General information

NPI: 1033220215
Provider Name (Legal Business Name): ERIN M REDWINE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 THORNTON RD
LITHIA SPRINGS GA
30122-1591
US

IV. Provider business mailing address

540 THORNTON RD
LITHIA SPRINGS GA
30122-1591
US

V. Phone/Fax

Practice location:
  • Phone: 770-745-5897
  • Fax:
Mailing address:
  • Phone: 770-745-5897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN012845
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN012845
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: