Individual
MATTHEW FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4020 ELNORA DR, MACON, GA 31210-1823
(478) 477-1228
Mailing address
4020 ELNORA DR, MACON, GA 31210-1823
(478) 477-1228
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN122727
GA
Other
Enumeration date
08/15/2022
Last updated
08/15/2022
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