MEDICARE: DR. FRED FRANCIS WORRALL II DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	011402	GA

General Provider Information

NPI Number	:	1164565172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED FRANCIS WORRALL II DDS

Provider Business Mailing Address
First Line	:	707 WHITLOCK AVE SW
Second Line	:	SUITE D29
City	:	MARIETTA
State	:	GA
Zip	:	30064-3000
Country	:	US
Telephone Number	:	770-792-2300
Fax Number	:	770-792-2436

Provider Business Practice Location Address
First Line	:	707 WHITLOCK AVE SW
Second Line	:	SUITE D29
City	:	MARIETTA
State	:	GA
Zip	:	30064-3083
Country	:	US
Telephone Number	:	770-792-2300
Fax Number	:	770-792-2436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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