=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710444286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEBEDIAH S CHRISTY DDS - HINESVILLE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2019
-----------------------------------------------------
Last Update Date | 06/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 849 W OGLETHORPE HWY STE 140
-----------------------------------------------------
City | HINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31313-4495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-348-1388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 70887
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44190-0887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEBEDIAH CHRISTY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 912-348-1388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------