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General NPI Number Information
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NPI Number | 1568225530
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Entity Type | Organization
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Legal Business Name | GEORGIA DENTAL PROFESSIONALS, PC
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 2785 LOGANVILLE HWY
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City | LOGANVILLE
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State | GA
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Zip | 30052-5082
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Country | US
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Telephone | 770-901-2145
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Fax | 770-901-2143
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Provider Business Mailing Address
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Address Line | 2785 LOGANVILLE HWY
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City | LOGANVILLE
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State | GA
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Zip | 30052-5082
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Country | US
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Telephone | 770-901-2145
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Fax | 770-901-2143
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Authorized Official
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Title or Position | CREDENTIALING
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Name | CEMYIRA MCDOUGAL
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Credential |
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Telephone | 217-764-8609
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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 |
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License Number State |
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