Healthcare Provider Details

I. General information

NPI: 1689836470
Provider Name (Legal Business Name): BRITTANY THOME HOOVER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY THOME HAYES DMD

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 OAKBROOK DR SUITE 200
NORCROSS GA
30093-2245
US

IV. Provider business mailing address

3238 KRISAM CREEK DR.
LOGANVILLE GA
30052
US

V. Phone/Fax

Practice location:
  • Phone: 770-449-0836
  • Fax: 770-441-0299
Mailing address:
  • Phone: 770-466-0474
  • Fax: 770-441-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13690
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: