Healthcare Provider Details

I. General information

NPI: 1346311479
Provider Name (Legal Business Name): ROBERT PAULEY JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 FLAT SHOALS RD
UNION CITY GA
30291-1573
US

IV. Provider business mailing address

4651 FLAT SHOALS RD
UNION CITY GA
30291-1573
US

V. Phone/Fax

Practice location:
  • Phone: 770-964-1469
  • Fax: 770-964-2105
Mailing address:
  • Phone: 770-964-1469
  • Fax: 770-964-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8906
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN010732
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: