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290 Highway 314 Ste A Fayetteville GA 30214-7813 | |
| (770) 460-6060 | |
| (770) 461-0541 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 290 Highway 314 Ste A, Fayetteville, Georgia |
| Authorized Official Name and Position | Kelli Walker (INSURANCE/CREDENTIALING) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
290 Highway 314 Ste A Fayetteville GA 30214-7813 Ph: (770) 460-6060 | 290 Highway 314 Ste A Fayetteville GA 30214-7813 Ph: (770) 460-6060 |
| NPI Number | 1407122799 |
|---|---|
| Provider Enumeration Date | 03/30/2012 |
| Last Update Date | 03/30/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407122799 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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