Provider Demographics
NPI:1295845543
Name:ADKINS, JUANITA SHIRLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:SHIRLEY
Last Name:ADKINS
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 1:400 MCDONOUGH PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8946
Mailing Address - Country:US
Mailing Address - Phone:770-957-5214
Mailing Address - Fax:
Practice Address - Street 1:400 MCDONOUGH PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8946
Practice Address - Country:US
Practice Address - Phone:770-957-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA750112165AMedicaid