Healthcare Provider Details

I. General information

NPI: 1427060813
Provider Name (Legal Business Name): DAVID P. TIMMIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 STEVENS ENTRY
PEACHTREE CITY GA
30269-4050
US

IV. Provider business mailing address

122 STONINGTON DR
PEACHTREE CITY GA
30269-1349
US

V. Phone/Fax

Practice location:
  • Phone: 770-487-3807
  • Fax: 770-487-1259
Mailing address:
  • Phone: 770-486-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: