Provider Demographics
NPI:1114140472
Name:JAMES, TY G (DMD)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:G
Last Name:JAMES
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 1:3000 CHAPEL HILL ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1999
Mailing Address - Country:US
Mailing Address - Phone:770-920-0112
Mailing Address - Fax:770-920-2226
Practice Address - Street 1:3000 CHAPEL HILL ROAD
Practice Address - Street 2:SUITE104
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1999
Practice Address - Country:US
Practice Address - Phone:770-920-0112
Practice Address - Fax:770-920-2226
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist