Organization
GEORGIA DEPARTMENT OF HUMAN RESOURCES
Active
Other names
Floyd County BOH- Mobile Dental Van
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER WADE SELLERS M.D. (MEDICAL DIRECTOR)
(706) 295-6704
Entity
Organization
Contact information
Practice address
1309 REDMOND RD NW, ROME, GA 30165-1307
(706) 802-5343
(706) 802-5681
Mailing address
1309 REDMOND RD NW, ROME, GA 30165-1307
(706) 802-5343
(706) 802-5681
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
025271
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000926879
—
GA
05
—
000926879A
—
GA
05
—
000926879B
—
GA
05
—
000926879D
—
GA
05
—
000926879E
—
GA
05
—
000926879F
—
GA
05
—
000926879G
—
GA
05
—
000926879H
—
GA
05
—
000926879I
—
GA
05
—
0009288679B
—
GA
Enumeration date
02/12/2007
Last updated
07/11/2008
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