Individual
MARY C DEMENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
361 FURYS FERRY RD, MARTINEZ, GA 30907-3047
(706) 869-2007
Mailing address
361 FURYS FERRY RD, MARTINEZ, GA 30907-3047
(706) 869-2007
(706) 869-2028
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
40493
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000697089C
—
GA
01
—
930047421
RAILROAD MEDICARE
GA
Enumeration date
08/17/2006
Last updated
04/03/2015
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