MEDICARE: DR. ROBERT PAULEY JR. DMD

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	8906	CO
2	1223G0001X	General Practice Dentistry	DN010732	GA

General Provider Information

NPI Number	:	1346311479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT PAULEY JR. DMD

Provider Business Mailing Address
First Line	:	4651 FLAT SHOALS RD
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-1573
Country	:	US
Telephone Number	:	770-964-1469
Fax Number	:	770-964-2105

Provider Business Practice Location Address
First Line	:	4651 FLAT SHOALS RD
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-1573
Country	:	US
Telephone Number	:	770-964-1469
Fax Number	:	770-964-2105

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

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	07/08/2007

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