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General NPI Number Information
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NPI Number | 1063973477
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Entity Type | Individual
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Provider Name | FATIN JWEINAT
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Gender | Female
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 1430 JOHN WESLEY GILBERT DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30912-0001
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Country | US
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Telephone | 706-721-2813
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Fax |
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Provider Business Mailing Address
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Address Line | 455 LINDSEY CT
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City | COMMERCE
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State | GA
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Zip | 30529-1149
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Country | US
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Telephone | 615-397-7109
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN015876
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License Number State | GA
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