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General NPI Number Information
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NPI Number | 1669922142
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Entity Type | Organization
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Legal Business Name | JEBEDIAH S. CHRISTY DDS - WAYCROSS PLLC
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 2271 MEMORIAL DR
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City | WAYCROSS
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State | GA
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Zip | 31501
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Country | US
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Telephone | 912-550-4012
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Fax | 912-287-9817
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220-3189
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Country | US
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Telephone | 315-454-6000
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Fax |
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Authorized Official
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Title or Position | PROVIDER RELATIONS
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Name | JENNIFER LA DUC
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Credential |
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Telephone | 315-454-6000
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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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