| South Georgia Periodontics, Pc | |
|
307 Georgetown Cir Valdosta GA 31602-4113 | |
| (229) 247-0437 | |
| (229) 242-4395 |
| Full Name | South Georgia Periodontics, Pc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 307 Georgetown Cir, Valdosta, Georgia |
| Authorized Official Name and Position | Brent B. Depta (OWNER) |
| Authorized Official Contact | 2292470437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Georgia Periodontics, Pc 307 Georgetown Cir Valdosta GA 31602-4113 Ph: (229) 247-0437 | South Georgia Periodontics, Pc 307 Georgetown Cir Valdosta GA 31602-4113 Ph: (229) 247-0437 |
| NPI Number | 1194981910 |
|---|---|
| Provider Enumeration Date | 07/31/2008 |
| Last Update Date | 07/31/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194981910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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