| |
516 Ga Highway 247 S Bonaire GA 31005-3865 | |
(478) 273-2562 | |
(478) 551-4152 |
Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 516 Ga Highway 247 S, Bonaire, Georgia |
Authorized Official Name and Position | Jessica Britt (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 2175405100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
516 Ga Highway 247 S Bonaire GA 31005-3865 Ph: () - | 516 Ga Highway 247 S Bonaire GA 31005-3865 Ph: (478) 273-2562 |
NPI Number | 1972165207 |
---|---|
Provider Enumeration Date | 07/08/2019 |
Last Update Date | 08/08/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1972165207 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |