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General NPI Number Information
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NPI Number | 1942140074
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Entity Type | Organization
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Legal Business Name | GA PROSTHO LLC
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 6320 SUGARLOAF PKWY
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City | DULUTH
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State | GA
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Zip | 30097-4334
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Country | US
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Telephone | 770-381-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 6320 SUGARLOAF PKWY
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City | DULUTH
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State | GA
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Zip | 30097-4334
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Country | US
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Telephone | 770-381-9333
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARINA YEFRUSI
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Credential | RDH
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Telephone | 770-381-9333
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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 |
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License Number State |
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