Organization
GUY W. MOORMAN, JR. DDS. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY LYNN SMITH (OFFICE MANAGER)
(912) 384-7400
Entity
Organization
Contact information
Practice address
1150 WARD STREET EXT W, DOUGLAS, GA 31533-1900
(912) 384-7400
Mailing address
1150 WARD STREET EXT W, DOUGLAS, GA 31533-1900
(912) 384-7400
(912) 384-7414
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN007456
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578698650
—
GA
Enumeration date
12/11/2015
Last updated
12/11/2015
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