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General NPI Number Information
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NPI Number | 1992977243
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Entity Type | Organization
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Legal Business Name | SOUTHERN GEORGIA ORAL SURGERY
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 790 FRANK COCHRAN DR STE 102
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City | HINESVILLE
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State | GA
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Zip | 31313-3991
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Country | US
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Telephone | 267-975-0197
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Fax |
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Provider Business Mailing Address
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Address Line | 790 FRANK COCHRAN DR STE 102
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City | HINESVILLE
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State | GA
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Zip | 31313-3991
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Country | US
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Telephone | 267-975-0197
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROGER MYERS
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Credential | DMD
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Telephone | 267-975-0197
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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 | NULL
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