MEDICARE: DR. JAMES J MCDONALD JR. D.M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	9015	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52160463-002	OTHER	GA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1770615825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES J MCDONALD JR. D.M.D.

Provider Business Mailing Address
First Line	:	1360 CADUCEUS WAY
Second Line	:	BLDG 500 STE 101
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-7300
Country	:	US
Telephone Number	:	706-548-0604
Fax Number	:	706-353-0884

Provider Business Practice Location Address
First Line	:	1360 CADUCEUS WAY
Second Line	:	BLDG 500 STE 101
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-7300
Country	:	US
Telephone Number	:	706-548-0604
Fax Number	:	706-353-0884

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	05/16/2019

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Directions to “ DR. JAMES J MCDONALD JR. D.M.D.” Practice Location

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