Healthcare Provider Details

I. General information

NPI: 1497990493
Provider Name (Legal Business Name): CHARLES W. POOLE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 OAKBROOK DR STE 440
NORCROSS GA
30093
US

IV. Provider business mailing address

1650 OAKBROOK DR STE 440
NORCROSS GA
30093
US

V. Phone/Fax

Practice location:
  • Phone: 770-446-8000
  • Fax: 770-446-1354
Mailing address:
  • Phone: 770-446-8000
  • Fax: 770-446-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN012801
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: