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General NPI Number Information
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NPI Number | 1396882783
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Entity Type | Organization
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Legal Business Name | ALLRED DENTAL GROUP LLC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 743 S 8TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4818
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Country | US
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Telephone | 770-228-6101
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Fax | 770-228-6170
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Provider Business Mailing Address
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Address Line | 743 S 8TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4818
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Country | US
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Telephone | 770-228-6101
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Fax | 770-228-6170
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHELLI ANNE CARROLL
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Credential |
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Telephone | 706-741-8433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 010469
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 014094
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 014960
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 014067
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License Number State | GA
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