Facts
- Status
- A
- Credential
- DMD
- Type
- Individual
- Enumeration date
- 2007-05-23
- Last updated
- 2014-07-16
Specialties
Licenses
- License ME
- 3088
- License GA
- DN014668
Location
- Practice location
- 276 POOLER PKWY STE A
- City
- POOLER GA
- Postal code
- 313225163
- Phone
- 207-737-9660
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.