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General NPI Number Information
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NPI Number | 1619652211
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Entity Type | Individual
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Provider Name | GEORGIA CAROLINE MAY MARS DMD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 276 MAGNOLIA DR
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City | RALEIGH
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State | MS
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Zip | 39153-6016
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Country | US
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Telephone | 601-782-9909
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Fax |
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Provider Business Mailing Address
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Address Line | 4324 N HONEYSUCKLE LN
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City | JACKSON
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State | MS
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Zip | 39211-6131
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Country | US
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Telephone | 601-624-4421
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4384-23
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License Number State | MS
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