Healthcare Provider Details

I. General information

NPI: 1164556528
Provider Name (Legal Business Name): HENRY PATRICK CAWLEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 VIRGINIA AVE N
TIFTON GA
31794-4250
US

IV. Provider business mailing address

611 VIRGINIA AVE N
TIFTON GA
31794-4250
US

V. Phone/Fax

Practice location:
  • Phone: 229-387-0700
  • Fax: 229-387-0705
Mailing address:
  • Phone: 229-387-0700
  • Fax: 229-387-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN010665
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: