Healthcare Provider Details

I. General information

NPI: 1720274798
Provider Name (Legal Business Name): DAVID P. TIMMS., D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 STEVENS ENTRY
PEACHTREE CITY GA
30269-4050
US

IV. Provider business mailing address

406 STEVENS ENTRY
PEACHTREE CITY GA
30269-4050
US

V. Phone/Fax

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

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: MS. BRIDGET J. COOKFAIR
Title or Position: PRACTICE MANAGER
Credential:
Phone: 770-487-3807