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General NPI Number Information
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NPI Number | 1841469210
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Entity Type | Organization
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Legal Business Name | MACON ORAL AND MAXILLOFACIAL SURGERY,P.C.
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 112 ARKWRIGHT LNDG
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City | MACON
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State | GA
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Zip | 31210-1364
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Country | US
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Telephone | 478-471-9779
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Fax | 478-471-9754
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Provider Business Mailing Address
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Address Line | 112 ARKWRIGHT LNDG
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City | MACON
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State | GA
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Zip | 31210-1364
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Country | US
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Telephone | 478-471-9779
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Fax | 478-471-9754
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DONA GURLEY
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Credential |
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Telephone | 478-471-9779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 011926
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License Number State | GA
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