Organization
CHILDREN AND TEEN ORTHO GROUP OF ALABAMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL WALKER (CREDENTIALING MANAGER)
(770) 744-4522
Entity
Organization
Contact information
Practice address
221 RICE MINE RD NE STE 260, TUSCALOOSA, AL 35406-2401
(205) 758-3341
(678) 550-5490
Mailing address
342 N MAIN ST STE 200, ALPHARETTA, GA 30009-8376
(205) 758-3341
(205) 366-1099
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
09/02/2016
Last updated
05/11/2021
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