Organization
GOFS STOCKBRIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GIANA HOUSTON (CFO)
(404) 384-1181
Entity
Organization
Contact information
Practice address
225 COUNTRY CLUB DR, #110, STOCKBRIDGE, GA 30281
(678) 905-9066
(678) 401-4725
Mailing address
225 COUNTRY CLUB DR, #110, STOCKBRIDGE, GA 30281
(678) 905-9066
(678) 401-4725
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DN014207
GA
Other
Enumeration date
01/26/2018
Last updated
01/26/2018
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