Healthcare Provider Details

I. General information

NPI: 1407962269
Provider Name (Legal Business Name): PICKRON ORTHODONTIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3294 MEDLOCK BRIDGE ROAD
NORCROSS GA
30092
US

IV. Provider business mailing address

3294 MEDLOCK BRIDGE ROAD
NORCROSS GA
30092
US

V. Phone/Fax

Practice location:
  • Phone: 770-448-8882
  • Fax: 770-446-5511
Mailing address:
  • Phone: 770-448-8882
  • Fax: 770-446-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GAY S LOWRY
Title or Position: EXECUTIVE DIRECTOR
Credential: EXECUTIVE DIRECTOR
Phone: 770-448-8882