| Paul Ivey Nettles Llc | |
|
1177 Garden Walk Blvd College Park GA 30349-6245 | |
| (770) 997-9090 | |
| Not Available |
| Full Name | Paul Ivey Nettles Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1177 Garden Walk Blvd, College Park, Georgia |
| Authorized Official Name and Position | Paul I Nettles (PRESIDENT) |
| Authorized Official Contact | 7709979090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Paul Ivey Nettles Llc 730 Highmeade Ter Alpharetta GA 30005-3755 Ph: (770) 337-0976 | Paul Ivey Nettles Llc 1177 Garden Walk Blvd College Park GA 30349-6245 Ph: (770) 997-9090 |
| NPI Number | 1063564078 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063564078 | NPI | - | NPPES |
| 0050949A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 11589 (Georgia) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 6742 (Georgia) | Primary |
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Ashford Dental Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2177 Godby Rd, Suite D, College Park, GA 30349 Phone: 404-763-3326 Fax: 404-763-3073 | |
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Jerry E Nutt Dds & Assoc Of College Park Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1571 Phoenix Blvd, College Park, GA 30349 Phone: 770-996-7700 | |
Vivid Smile Dental Center Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1177 Garden Walk Blvd, College Park, GA 30349 Phone: 770-997-9090 |