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Organization
ORAL SURGERY OF GEORGIA LLC
Active
Organization
ORAL SURGERY OF GEORGIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES O COULTER DMD (OWNER)
(404) 389-1950
Entity
Organization
Contact information
Practice address
5590 ROSWELL RD, STE 270, SANDY SPRINGS, GA 30342-1909
(404) 389-1950
Mailing address
1350 SPRING ST NW, STE 600, ATLANTA, GA 30309-2864
(404) 389-1950
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN013607
GA
Other
Enumeration date
03/20/2014
Last updated
03/20/2014
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