| Southern Oral Surgery Pc | |
|
614 S 8th St Griffin GA 30224-4214 | |
| (770) 228-1010 | |
| (678) 692-0242 |
| Full Name | Southern Oral Surgery Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 614 S 8th St, Griffin, Georgia |
| Authorized Official Name and Position | Eric D Ferrara (OWNER) |
| Authorized Official Contact | 7702281010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Oral Surgery Pc 614 S 8th St Griffin GA 30224-4214 Ph: (770) 228-1010 | Southern Oral Surgery Pc 614 S 8th St Griffin GA 30224-4214 Ph: (770) 228-1010 |
| NPI Number | 1881629392 |
|---|---|
| Provider Enumeration Date | 07/12/2006 |
| Last Update Date | 10/12/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881629392 | NPI | - | NPPES |
| 003109984A | Medicaid | GA | |
| 178058507B | Medicaid | GA | |
| 178058507A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN013416 (Georgia) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN012761 (Georgia) | Secondary |
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