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Organization
JIMMY F MAXWELL DMD PC
Active
Organization
JIMMY F MAXWELL DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIMMY FOSTER MAXWELL DMD PC (OWNER DENTIST)
(229) 246-3023
Entity
Organization
Contact information
Practice address
500 AMELIA AVENUE, BAINBRIDGE, GA 39818-0727
(229) 246-3023
(229) 246-3024
Mailing address
PO BOX 727, 500 AMELIA AVENUE, BAINBRIDGE, GA 39818-0727
(229) 246-3023
(229) 246-3024
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN009648
GA
122300000X
Dentist
DN9728
FL
122300000X
Dentist
DS0000007704
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00245341A4
—
GA
01
—
RPHO11407
GEORGIA BOARD OF PHARMACY
GA
Enumeration date
04/19/2006
Last updated
09/26/2012
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