Healthcare Provider Details

I. General information

NPI: 1154388726
Provider Name (Legal Business Name): JAMES C SKOGNES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 GEORGIA BELLE CT
NORCROSS GA
30093-2667
US

IV. Provider business mailing address

PO BOX 897
LAWRENCEVILLE GA
30046-0897
US

V. Phone/Fax

Practice location:
  • Phone: 770-638-5708
  • Fax:
Mailing address:
  • Phone: 770-339-4283
  • Fax: 770-963-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN012603
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: