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General NPI Number Information
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NPI Number | 1407019243
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Entity Type | Individual
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Provider Name | TINA MICHELL CHAMPION D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 1980M N COLUMBIA ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-2020
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Country | US
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Telephone | 478-387-7015
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Fax |
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Provider Business Mailing Address
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Address Line | 1547 BELL FLOWER CT
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City | STONE MOUNTAIN
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State | GA
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Zip | 30088-3707
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Country | US
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Telephone | 708-218-3296
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Fax | 708-575-0401
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019025754
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN015080
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN015080
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License Number State | GA
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