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365 W Pike St Lawrenceville GA 30046-3205 | |
| (770) 963-2424 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 365 W Pike St, Lawrenceville, Georgia |
| Authorized Official Name and Position | Jennifer Lynn Mccoy (MANAGING MEMBER) |
| Authorized Official Contact | 5626651366 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
365 W Pike St Lawrenceville GA 30046-3205 Ph: (770) 963-2424 | 365 W Pike St Lawrenceville GA 30046-3205 Ph: (770) 963-2424 |
| NPI Number | 1982016523 |
|---|---|
| Provider Enumeration Date | 06/02/2014 |
| Last Update Date | 07/21/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982016523 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN013561 (Georgia) | Primary |
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