Organization
SGPC, PC
Active
Other names
South Georgia Pediatric Denitstry
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH C POWELL DDS (OWNER/DENTIST)
(229) 247-3200
Entity
Organization
Contact information
Practice address
3227 N OAK STREET EXT, SUITE A, VALDOSTA, GA 31605-7416
(229) 247-3200
Mailing address
3227 N OAK STREET EXT, SUITE A, VALDOSTA, GA 31605-7416
(229) 247-3200
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN014976
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003162889B
—
GA
05
—
00917067B
—
GA
05
—
102640352A
—
GA
Enumeration date
11/23/2010
Last updated
02/01/2016
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