Individual
DR. TINA MICHELL CHAMPION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1980M N COLUMBIA ST, MILLEDGEVILLE, GA 31061-2020
(478) 387-7015
Mailing address
1547 BELL FLOWER CT, STONE MOUNTAIN, GA 30088-3707
(708) 218-3296
(708) 575-0401
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN015080
GA
1223G0001X
General Practice Dentistry
019025754
IL
1223G0001X
General Practice Dentistry
DN015080
GA
Other
Enumeration date
07/02/2008
Last updated
05/27/2022
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