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Individual
DR. DOUGLAS COURTNEY MAXWELL
Active
Individual
DR. DOUGLAS COURTNEY MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11562
GA
1223G0001X
General Practice Dentistry
11562
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000963256A
—
GA
01
—
100049
AVESIS
GA
01
—
9183256
DORAL
GA
01
—
986622
UNITED CONCORDIA
GA
Enumeration date
12/19/2006
Last updated
08/01/2012
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