=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093152845
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSEY CLARK ANDERSON DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2013
-----------------------------------------------------
Last Update Date | 07/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7316 SPOUT SPRINGS RD STE 204
-----------------------------------------------------
City | FLOWERY BRANCH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30542-5620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-853-1890
-----------------------------------------------------
Fax | 770-741-0138
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4212 MCEVER RD
-----------------------------------------------------
City | OAKWOOD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30566-2237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-534-1816
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN014587
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------