Individual
CHANDLER GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1360 CADUCEUS WAY, WATKINSVILLE, GA 30677-7300
(706) 543-3629
Mailing address
2131 STRASBURG CT, DUNWOODY, GA 30338-5218
(404) 637-6723
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN123476
GA
Other
Enumeration date
07/15/2024
Last updated
07/15/2024
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