Provider Demographics
NPI:1043888118
Name:JERNIGAN, JOSHUA CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:CHRISTOPHER
Last Name:JERNIGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BEAVERS RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-6161
Mailing Address - Country:US
Mailing Address - Phone:678-899-0651
Mailing Address - Fax:
Practice Address - Street 1:138 OAKLAND PKWY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-7200
Practice Address - Country:US
Practice Address - Phone:229-432-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1223091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice