Provider Demographics
NPI:1376689737
Name:GODFREY, GRIER (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRIER
Middle Name:
Last Name:GODFREY
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:MACON-BIBB COUNTY HEALTH DEPARTMENT
Mailing Address - Street 2:171 EMERY HIGHWAY
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217
Mailing Address - Country:US
Mailing Address - Phone:478-749-0109
Mailing Address - Fax:478-749-0120
Practice Address - Street 1:MACON-BIBB COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:171 EMERY HIGHWAY
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217
Practice Address - Country:US
Practice Address - Phone:478-749-0109
Practice Address - Fax:478-749-0120
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0087651223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health