| Athens Family Dental Center | |
|
3380 Old Jefferson Rd Athens GA 30607-1480 | |
| (706) 548-3279 | |
| (706) 546-6475 |
| Full Name | Athens Family Dental Center |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3380 Old Jefferson Rd, Athens, Georgia |
| Authorized Official Name and Position | Robert Samuel Fogg (BUSINESS MANAGER) |
| Authorized Official Contact | 7065483279 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Athens Family Dental Center 3380 Old Jefferson Rd Athens GA 30607-1480 Ph: (706) 548-3279 | Athens Family Dental Center 3380 Old Jefferson Rd Athens GA 30607-1480 Ph: (706) 548-3279 |
| NPI Number | 1114198108 |
|---|---|
| Provider Enumeration Date | 03/18/2008 |
| Last Update Date | 03/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114198108 | NPI | - | NPPES |
| 00176778C | Medicaid | GA | |
| 00862705A | Medicaid | GA | |
| 00915516A | Medicaid | GA | |
| 00508065A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 006805 (Georgia) | Primary |
| 1223G0001X | Dentist - General Practice | 009000 (Georgia) | Secondary |
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