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General NPI Number Information
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NPI Number | 1487164828
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Entity Type | Organization
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Legal Business Name | LITTLE P.C.
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 236 TOM HILL SR BLVD
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City | MACON
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State | GA
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Zip | 31210-1815
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Country | US
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Telephone | 843-990-9998
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Fax | 864-670-5285
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Provider Business Mailing Address
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Address Line | 250 ADLEY WAY
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City | GREENVILLE
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State | SC
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Zip | 29607-6511
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Country | US
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Telephone | 843-990-9998
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Fax | 864-640-5285
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Authorized Official
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Title or Position | DIRECTOR OF INSURANCE
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Name | MONIQUE TUCKER
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Credential |
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Telephone | 843-990-9998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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