Organization
ORAL AN IMPLANT SURGERY SPECIALISTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DURWOOD M JOHNSON JR. DMD (DOCTOR)
(770) 461-2101
Entity
Organization
Contact information
Practice address
1260 HIGHWAY 54 W, SUITE 200, FAYETTEVILLE, GA 30214-4514
(770) 461-2101
(770) 460-1292
Mailing address
1260 HIGHWAY 54 W, SUITE 200, FAYETTEVILLE, GA 30214-4514
(770) 461-2101
(770) 460-1292
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
007973
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000189351B
—
GA
Enumeration date
09/10/2012
Last updated
05/10/2013
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