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General NPI Number Information
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NPI Number | 1588589105
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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 | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 841 HIGHWAY 81 E
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City | MCDONOUGH
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State | GA
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Zip | 30252-2982
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Country | US
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Telephone | 470-264-2750
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Fax |
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Provider Business Mailing Address
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Address Line | 841 HIGHWAY 81 E
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City | MCDONOUGH
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State | GA
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Zip | 30252-2982
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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