Individual
DR. LEROY JUSTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
.D.D.S
Contact information
Practice address
12900 BROAD ST, SPARTA, GA 31087-1737
(706) 444-6886
(706) 444-7779
Mailing address
12900 BROAD ST, SPARTA, GA 31087-1737
(706) 444-6886
(706) 444-7779
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8775
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00254493A
—
GA
05
—
00254943B
—
GA
Enumeration date
05/21/2007
Last updated
07/12/2007
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