Individual
DR. DOUGLAS COURTNEY MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2415 ANDOVER DR, VALDOSTA, GA 31602-1280
(229) 671-1900
(229) 671-1999
Mailing address
2415 ANDOVER DR, VALDOSTA, GA 31602-1280
(229) 671-1900
(229) 671-1999
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11562
GA
1223G0001X
General Practice Dentistry
11562
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000963256A
—
GA
01
—
100049
AVESIS
GA
01
—
9183256
DORAL
GA
01
—
986622
UNITED CONCORDIA
GA
Enumeration date
12/19/2006
Last updated
08/01/2012
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