Individual
DR. JIMMY FOSTER MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., P.C.
Contact information
Practice address
500 AMELIA AVE, POB 727, BAINBRIDGE, GA 39819-4356
(229) 246-3023
(229) 246-3024
Mailing address
500 AMELIA AVE, PO BOX 727, BAINBRIDGE, GA 39819-4356
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
—
RPH011407
PHARMACY LICENSE
GA
Enumeration date
03/25/2010
Last updated
03/25/2010
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