Provider Demographics
NPI:1073662540
Name:WELCH, KATHY POWERS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:POWERS
Last Name:WELCH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5223 RIVERSIDE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1050
Mailing Address - Country:US
Mailing Address - Phone:478-477-8884
Mailing Address - Fax:478-477-8933
Practice Address - Street 1:5223 RIVERSIDE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1050
Practice Address - Country:US
Practice Address - Phone:478-477-8884
Practice Address - Fax:478-477-8933
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0107061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice