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Organization
PDA SPECIALTY OF GEORGIA, LLC
Active
Organization
PDA SPECIALTY OF GEORGIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE MARLOW (CREDENTIALING SUPERVISOR)
(724) 698-2119
Entity
Organization
Contact information
Practice address
3466 COBB PKWY NW STE 170, ACWORTH, GA 30101-5768
(770) 203-1711
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
NULL
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
Other
Enumeration date
03/07/2018
Last updated
03/17/2018
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