Organization
CENTRAL GEORGIA ORAL AND MAXILLOFACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLYDE D MARLOW DDS (PRESIDENT)
(478) 745-0200
Entity
Organization
Contact information
Practice address
740 FIRST ST., MACON, GA 31201-6840
(478) 745-0200
Mailing address
740 FIRST ST., MACON, GA 31201-6840
(478) 745-0200
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6880
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6880
LICENSE
GA
Enumeration date
04/18/2007
Last updated
10/01/2008
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