Individual
DR. JOHN LOUIS POURNELLE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
607 3RD ST N, SOPERTON, GA 30457-1160
(912) 529-6171
Mailing address
607 3RD ST N, SOPERTON, GA 30457-1160
(912) 529-6171
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN009368
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00221064A
—
GA
Enumeration date
08/17/2006
Last updated
07/09/2007
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