MEDICARE: DR. DONALD ROBERT CORRELL 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	GA7828	GA

General Provider Information

NPI Number	:	1861599425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD ROBERT CORRELL DDS

Provider Business Mailing Address
First Line	:	5040 SNAPFINGER WOODS DR
Second Line	:	SUITE 203
City	:	DECATUR
State	:	GA
Zip	:	30035-4020
Country	:	US
Telephone Number	:	770-981-9700
Fax Number	:	770-323-6226

Provider Business Practice Location Address
First Line	:	5040 SNAPFINGER WOODS DR
Second Line	:	SUITE 203
City	:	DECATUR
State	:	GA
Zip	:	30035-4020
Country	:	US
Telephone Number	:	770-981-9700
Fax Number	:	770-323-6226

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	07/08/2007

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