MEDICARE: DR. NEELY THORNTON

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	DN013317	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609953413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEELY THORNTON

Provider Business Mailing Address
First Line	:	707 WHITLOCK AVE SW
Second Line	:	SUITE C25
City	:	MARIETTA
State	:	GA
Zip	:	30064-3000
Country	:	US
Telephone Number	:	770-422-7727
Fax Number	:	770-427-8009

Provider Business Practice Location Address
First Line	:	707 WHITLOCK AVE SW
Second Line	:	SUITE C25
City	:	MARIETTA
State	:	GA
Zip	:	30064-3000
Country	:	US
Telephone Number	:	770-422-7727
Fax Number	:	770-427-8009

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/04/2015

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Directions to “ DR. NEELY THORNTON ” Practice Location

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