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1728 Highway 138 Se Suite 130 Conyers GA 30013-5759 | |
| (770) 761-1330 | |
| (770) 761-1991 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 1728 Highway 138 Se, Conyers, Georgia |
| Authorized Official Name and Position | John C Martin (ORTHODONTIST) |
| Authorized Official Contact | 7707611330 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1728 Highway 138 Se Suite 130 Conyers GA 30013-5759 Ph: (770) 761-1330 | 1728 Highway 138 Se Suite 130 Conyers GA 30013-5759 Ph: (770) 761-1330 |
| NPI Number | 1679619118 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679619118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 008367 (Georgia) | Primary |
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