| Marsha Jordan Holloway, Llc | |
|
200 12th St W Suite F Tifton GA 31794-3978 | |
| (229) 386-1616 | |
| (229) 386-4828 |
| Full Name | Marsha Jordan Holloway, Llc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 200 12th St W, Tifton, Georgia |
| Authorized Official Name and Position | Amanda Cooper (INSURANCE COORDINATOR) |
| Authorized Official Contact | 2293861616 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marsha Jordan Holloway, Llc 200 12th St W Suite F Tifton GA 31794-3978 Ph: (229) 386-1616 | Marsha Jordan Holloway, Llc 200 12th St W Suite F Tifton GA 31794-3978 Ph: (229) 386-1616 |
| NPI Number | 1992856918 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992856918 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 010688 (Georgia) | Primary |
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