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General NPI Number Information
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NPI Number | 1780897124
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Entity Type | Organization
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Legal Business Name | R.L.O'KELLEY D.D.S.P.A.
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 3100 E SHADOWLAWN AVE NE
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City | ATLANTA
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State | GA
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Zip | 30305-2406
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Country | US
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Telephone | 404-261-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 E SHADOWLAWN AVE NE
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City | ATLANTA
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State | GA
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Zip | 30305-2406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | DR. ROBERT L O'KELLEY
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Credential |
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Telephone | 404-261-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7464
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License Number State | GA
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