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General NPI Number Information
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NPI Number | 1730083239
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Entity Type | Organization
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Legal Business Name | JL POURNELLE JR DMD PC
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 5580 N THIRD ST
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City | SOPERTON
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State | GA
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Zip | 30457-2007
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Country | US
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Telephone | 912-529-6171
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Fax | 912-529-6500
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Provider Business Mailing Address
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Address Line | 5580 N THIRD ST
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City | SOPERTON
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State | GA
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Zip | 30457-2007
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Country | US
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Telephone | 912-529-6171
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Fax | 912-529-6500
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN LOUIS POURNELLE JR.
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Credential | DMD
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Telephone | 912-529-6172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | NULL
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