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General NPI Number Information
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NPI Number | 1205186863
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Entity Type | Organization
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Legal Business Name | GOLDEN ISLES ORAL SURGERY, L.L.C.
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 17 PROFESSIONAL DRIVE SUITE 100
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City | BRUNSWICK
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State | GA
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Zip | 31520-3794
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Country | US
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Telephone | 912-264-6420
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Fax | 912-264-6242
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Provider Business Mailing Address
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Address Line | 17 PROFESSIONAL DRIVE SUITE 100
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City | BRUNSWICK
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State | GA
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Zip | 31520-3794
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Country | US
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Telephone | 912-264-6420
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Fax | 912-264-6242
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER E. HALL
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Credential | D.M.D.
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Telephone | 912-264-6420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN011864
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License Number State | GA
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