Provider Demographics
NPI:1033238795
Name:IVEY, NORMAN TYRUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:TYRUS
Last Name:IVEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 FORSYTH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8132
Mailing Address - Country:US
Mailing Address - Phone:478-741-0044
Mailing Address - Fax:478-745-5061
Practice Address - Street 1:1902 FORSYTH ST
Practice Address - Street 2:SUITE C
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8132
Practice Address - Country:US
Practice Address - Phone:478-741-0044
Practice Address - Fax:478-745-5061
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist