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General NPI Number Information
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NPI Number | 1316208341
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Entity Type | Organization
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Legal Business Name | ULYSSES L. MARABLE III, DMD, LLC
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 1030 PEACH PARKWAY, STE 9
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City | FORT VALLEY
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State | GA
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Zip | 31030
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Country | US
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Telephone | 478-825-3000
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Fax | 478-825-3099
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Provider Business Mailing Address
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Address Line | 1030 PEACH PARKWAY, STE 9
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City | FORT VALLEY
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State | GA
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Zip | 31030
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Country | US
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Telephone | 478-825-3000
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Fax | 478-825-3099
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. ULYSSES L MARABLE III
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Credential | DMD
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Telephone | 478-825-3000
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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 | 13223
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License Number State | GA
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