Organization
CLASSIC CITY ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARLA ROBIN OLIVER (INSURANCE COORDINATOR)
(706) 549-4748
Entity
Organization
Contact information
Practice address
600 OGLETHORPE AVE, ATHENS, GA 30606-2263
(706) 549-4748
(706) 705-1650
Mailing address
600 OGLETHORPE AVE, ATHENS, GA 30606-2263
(706) 549-4748
(706) 705-1650
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
012101
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669591947
NPI
GA
Enumeration date
11/09/2015
Last updated
11/09/2015
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