| Grimsley Dental Clinic, Llc | |
|
115 N Cuthbert St Colquitt GA 39837-3401 | |
| (229) 758-3345 | |
| (229) 758-3339 |
| Full Name | Grimsley Dental Clinic, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 115 N Cuthbert St, Colquitt, Georgia |
| Authorized Official Name and Position | Joseph W Grimsley (DENTIST) |
| Authorized Official Contact | 2297583345 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grimsley Dental Clinic, Llc 115 N Cuthbert St Colquitt GA 39837-3401 Ph: (229) 758-3345 | Grimsley Dental Clinic, Llc 115 N Cuthbert St Colquitt GA 39837-3401 Ph: (229) 758-3345 |
| NPI Number | 1265681092 |
|---|---|
| Provider Enumeration Date | 09/17/2008 |
| Last Update Date | 09/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265681092 | NPI | - | NPPES |
| 300014425A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN013335 (Georgia) | Primary |
| 261QD0000X | Clinic/center - Dental | DN010031 (Georgia) | Secondary |
Colquitt Dental Care,llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 115 N Cuthbert St, Colquitt, GA 39837 Phone: 229-758-3345 Fax: 229-758-3339 |