Organization
VALDOSTA ORAL AND MAXILLOFACIAL SURGEONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANICE MARTIN (ADMINISTRATIVE ASSISTANT)
(229) 247-5590
Entity
Organization
Contact information
Practice address
2720 N OAK ST, VALDOSTA, GA 31602-1781
(229) 247-5590
(229) 241-0698
Mailing address
2720 N OAK ST, VALDOSTA, GA 31602-1781
(229) 247-5590
(229) 241-0698
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN008219
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP6639
MEDICARE GROUP NUMBER
GA
Enumeration date
05/08/2008
Last updated
05/08/2008
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