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2900 Glynn Ave Brunswick GA 31520-4844 | |
| (912) 342-7049 | |
| (912) 342-7942 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2900 Glynn Ave, Brunswick, Georgia |
| Authorized Official Name and Position | George Michael Wommack (OWNER) |
| Authorized Official Contact | 9123427049 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2900 Glynn Ave Brunswick GA 31520-4844 Ph: (912) 342-7049 | 2900 Glynn Ave Brunswick GA 31520-4844 Ph: (912) 342-7049 |
| NPI Number | 1760775043 |
|---|---|
| Provider Enumeration Date | 05/19/2011 |
| Last Update Date | 05/19/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760775043 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN012803 (Georgia) | Primary |
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