Organization
EPP GEORGIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI GORLITZ (CONTRACTING & CREDENTIALING MANAGER)
(248) 505-9977
Entity
Organization
Contact information
Practice address
3275 MARKET PLACE BLVD STE 200, CUMMING, GA 30041-7978
(770) 781-5990
Mailing address
5115 MARYLAND WAY STE 115, BRENTWOOD, TN 37027-7512
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
06/26/2020
Last updated
06/26/2020
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