Provider Demographics
NPI:1235247644
Name:BOBBY R CHILDREE DMD PC
Entity Type:Organization
Organization Name:BOBBY R CHILDREE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION (PC)
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CHILDREE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-692-2646
Mailing Address - Street 1:175 SOUTH MAIN STREET
Mailing Address - Street 2:PO BOX 698
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143
Mailing Address - Country:US
Mailing Address - Phone:706-692-2646
Mailing Address - Fax:706-253-3202
Practice Address - Street 1:175 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:706-692-2646
Practice Address - Fax:706-253-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty