# PORT CITY FAMILY DENTAL ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417112533
- **Authorized official:** MRS. SUZI RUSH-KRAFT (OFFICE MANAGER)
- **Authorized official phone:** (229) 246-5081

## Contact information

- **Practice address:** 709 E SHOTWELL ST, BAINBRIDGE, GA 39819-4063
- **Practice address phone:** (229) 246-5081
- **Practice address fax:** (229) 246-5011
- **Mailing address:** POST OFFICE BOX 1307, BAINBRIDGE, GA 39818
- **Mailing address phone:** (229) 246-5081
- **Mailing address fax:** (229) 246-5011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 9222 | GA | Yes |

## Other

- **Enumeration date:** 07/29/2008
- **Last updated:** 07/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00205927A | — | GA |
| 05 | — | 335406129B | — | GA |