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General NPI Number Information
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NPI Number | 1700802857
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Entity Type | Individual
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Provider Name | PHILLIP L. PARHAM JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1107 MEMORIAL DR SUITE G01
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City | DALTON
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State | GA
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Zip | 30720-8662
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Country | US
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Telephone | 706-278-5344
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Fax | 706-278-8816
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Provider Business Mailing Address
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Address Line | 1107 MEMORIAL DR SUITE G01
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City | DALTON
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State | GA
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Zip | 30720-8662
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Country | US
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Telephone | 706-278-5344
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Fax | 706-278-8816
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN009654
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License Number State | GA
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