Individual
JONATHAN MAXWELL CHRISENBERRY THREADGILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1000 JOHNSON FERRY RD BLDG H, MARIETTA, GA 30068-5518
(770) 977-0364
(678) 483-8487
Mailing address
1000 JOHNSON FERRY RD BLDG H, MARIETTA, GA 30068-5518
(678) 819-6536
(678) 483-8487
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN014348
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
993983
UNITED CONCORDIA
PA
Enumeration date
11/28/2006
Last updated
07/21/2022
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